Abstract
Post-transplantation lymphoproliferative disorder is an infrequent complication after hematopoietic stem cell transplantation. It is hypothesized that lack of T-cell surveillance following transplantation permits reactivation of latent EBV leading to polyclonal B-cell expansion and finally outgrowth of a predominant clone. Most cases are of donor origin. Here, we describe an 8-year old boy with early onset post-transplantation lymphoproliferative disorder following matched-unrelated stem cell transplantation for high-risk T-cell leukemia whose disease was unusual for two reasons. First, his B-cell clone was of host origin and, in contrast to the few PTLD of host origin described so far, not associated with autologous reconstitution. Secondly, using clonal analysis, we could retrospectively show that the B-cell clone emerged during consolidation chemotherapy for T-cell leukemia, 3 months before stem cell transplantation.
MeSH terms
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Murine-Derived
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Antilymphocyte Serum / administration & dosage
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Asparaginase / administration & dosage
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Asparaginase / adverse effects
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B-Lymphocytes / pathology*
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Child
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Clone Cells / pathology*
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Combined Modality Therapy
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Cyclophosphamide / administration & dosage
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Cyclosporine / adverse effects
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Cyclosporine / therapeutic use
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Cytarabine / administration & dosage
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Daunorubicin / administration & dosage
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Daunorubicin / adverse effects
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Dexamethasone / administration & dosage
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Epstein-Barr Virus Infections / complications*
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Etoposide / administration & dosage
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Etoposide / pharmacology
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Fatal Outcome
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Glucocorticoids / administration & dosage
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Glucocorticoids / adverse effects
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Graft vs Host Disease / drug therapy
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Herpesvirus 4, Human / isolation & purification
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Humans
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / therapeutic use
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Leukemia-Lymphoma, Adult T-Cell / drug therapy
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Leukemia-Lymphoma, Adult T-Cell / pathology
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Leukemia-Lymphoma, Adult T-Cell / surgery*
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Lymphocyte Transfusion
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Lymphoproliferative Disorders / drug therapy
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Lymphoproliferative Disorders / etiology*
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Lymphoproliferative Disorders / pathology
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Lymphoproliferative Disorders / virology
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Male
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Postoperative Complications / drug therapy
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Postoperative Complications / etiology*
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Postoperative Complications / pathology
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Postoperative Complications / virology
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Prednisolone / adverse effects
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Prednisolone / therapeutic use
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Rituximab
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Time Factors
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Transplantation Chimera
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Transplantation Conditioning
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Vincristine / administration & dosage
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Vincristine / adverse effects
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Virus Activation / drug effects
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Whole-Body Irradiation
Substances
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Antilymphocyte Serum
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Glucocorticoids
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Immunosuppressive Agents
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Cytarabine
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Rituximab
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Vincristine
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Etoposide
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Dexamethasone
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Cyclosporine
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Cyclophosphamide
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Prednisolone
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Asparaginase
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Daunorubicin