Epstein-Barr virus-associated B-cell lymphoma secondary to FCD-C therapy in patients with peripheral T-cell lymphoma

Int J Hematol. 2008 Nov;88(4):434-440. doi: 10.1007/s12185-008-0176-2. Epub 2008 Oct 7.

Abstract

Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorders occur at an increasing frequency in various hereditary and acquired states of immune dysfunction. In a few cases of T-cell lymphoma, especially in angioimmunoblastic T-cell lymphoma (AILT), EBV-associated B-cell lymphoproliferative disorders have been reported. Here, we present two cases of EBV-associated B-cell lymphoma after treatment of T-cell lymphoma (AILT and peripheral T-cell lymphoma, unspecified, PTCL-NOS) with a regimen containing alemtuzumab and fludarabine. Conventional and immunohistological tissue staining showed the typical features of highly proliferating diffuse large B-cell lymphoma in both cases. The monoclonal B-cell population displayed EBV latency type III. At the time of diagnosis the cellular immune status of both patients was severely compromised with an absolute CD4 T-cell count below <120 microl(-1). Our observation supports the notion that combination of cytotoxic drugs and immunosuppressive antibodies in patients with T-cell lymphoma may severely aggravate the already present immunodeficiency. We suggest to monitor the cellular immune status in combination with the EBV load in high risk patients for early detection-and possibly intervention-of EBV-associated lymphoma.

Publication types

  • Case Reports

MeSH terms

  • Alemtuzumab
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm / administration & dosage
  • Antibodies, Neoplasm / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Cytarabine / administration & dosage
  • Cytarabine / adverse effects
  • Epstein-Barr Virus Infections / chemically induced
  • Epstein-Barr Virus Infections / pathology*
  • Female
  • Herpesvirus 4, Human*
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / chemically induced
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Lymphoma, T-Cell / chemically induced
  • Lymphoma, T-Cell / pathology*
  • Male
  • Middle Aged
  • Neoplasms, Second Primary / drug therapy*
  • Neoplasms, Second Primary / pathology
  • Virus Latency / drug effects

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm
  • Cytarabine
  • Alemtuzumab