Posttransplantation Lymphoproliferative Disease Treated by Retransplantation
Epstein–Barr virus- (EBV-) induced posttransplantation lymphoproliferative disease (PTLD) is a life-threatening complication following allogeneic stem cell transplantation. The main risk factor is anti-thymocyte globulin (ATG). Patients who fail first-line treatment with rituximab have a poor progno...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Immunology |
| Online Access: | http://dx.doi.org/10.1155/2020/9403123 |
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| _version_ | 1832566164556873728 |
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| author | Ingerid Weum Abrahamsen Bjørn Christer Grønvold Else Marit Inderberg Nadia Mensali Jonas Mattsson Tobias Gedde-Dahl |
| author_facet | Ingerid Weum Abrahamsen Bjørn Christer Grønvold Else Marit Inderberg Nadia Mensali Jonas Mattsson Tobias Gedde-Dahl |
| author_sort | Ingerid Weum Abrahamsen |
| collection | DOAJ |
| description | Epstein–Barr virus- (EBV-) induced posttransplantation lymphoproliferative disease (PTLD) is a life-threatening complication following allogeneic stem cell transplantation. The main risk factor is anti-thymocyte globulin (ATG). Patients who fail first-line treatment with rituximab have a poor prognosis. Though adoptive transfer of EBV-specific T cells is a potentially effective option, it is not readily available. In this case report, the patient developed PTLD following transplantation for aplastic anemia using ATG as part of the conditioning. He failed rituximab treatment and developed graft failure. We were aware that the stem cell donor had a recent EBV infection prior to transplantation, whereas the patient most likely was EBV negative before transplant. We describe our strategy to meet the patient’s urgent need for EBV-specific T cells, as well as new hematopoietic stem cells. The same donor was used for a second transplant, using peripheral blood stem cells. The conditioning used was thiotepa/busulfan/fludarabin with a single dose of cyclophosphamide after transplant as graft-versus-host disease (GVHD) prophylaxis. The EBV DNA levels fell when conditioning was started, and have been undetectable since day +15 and remained so till 18 months after transplantation. The patient is doing well. This case reports successful use of cyclophosphamide after transplantation as GVHD prophylaxis, preserving virus-specific immunity. |
| format | Article |
| id | doaj-art-d772f92942cf4720a03d1f2ef7c95a60 |
| institution | Kabale University |
| issn | 2090-6609 2090-6617 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Immunology |
| spelling | doaj-art-d772f92942cf4720a03d1f2ef7c95a602025-02-03T01:04:59ZengWileyCase Reports in Immunology2090-66092090-66172020-01-01202010.1155/2020/94031239403123Posttransplantation Lymphoproliferative Disease Treated by RetransplantationIngerid Weum Abrahamsen0Bjørn Christer Grønvold1Else Marit Inderberg2Nadia Mensali3Jonas Mattsson4Tobias Gedde-Dahl5Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayDepartment of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayDepartment of Cellular Therapy, Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, NorwayDepartment of Cellular Therapy, Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayEpstein–Barr virus- (EBV-) induced posttransplantation lymphoproliferative disease (PTLD) is a life-threatening complication following allogeneic stem cell transplantation. The main risk factor is anti-thymocyte globulin (ATG). Patients who fail first-line treatment with rituximab have a poor prognosis. Though adoptive transfer of EBV-specific T cells is a potentially effective option, it is not readily available. In this case report, the patient developed PTLD following transplantation for aplastic anemia using ATG as part of the conditioning. He failed rituximab treatment and developed graft failure. We were aware that the stem cell donor had a recent EBV infection prior to transplantation, whereas the patient most likely was EBV negative before transplant. We describe our strategy to meet the patient’s urgent need for EBV-specific T cells, as well as new hematopoietic stem cells. The same donor was used for a second transplant, using peripheral blood stem cells. The conditioning used was thiotepa/busulfan/fludarabin with a single dose of cyclophosphamide after transplant as graft-versus-host disease (GVHD) prophylaxis. The EBV DNA levels fell when conditioning was started, and have been undetectable since day +15 and remained so till 18 months after transplantation. The patient is doing well. This case reports successful use of cyclophosphamide after transplantation as GVHD prophylaxis, preserving virus-specific immunity.http://dx.doi.org/10.1155/2020/9403123 |
| spellingShingle | Ingerid Weum Abrahamsen Bjørn Christer Grønvold Else Marit Inderberg Nadia Mensali Jonas Mattsson Tobias Gedde-Dahl Posttransplantation Lymphoproliferative Disease Treated by Retransplantation Case Reports in Immunology |
| title | Posttransplantation Lymphoproliferative Disease Treated by Retransplantation |
| title_full | Posttransplantation Lymphoproliferative Disease Treated by Retransplantation |
| title_fullStr | Posttransplantation Lymphoproliferative Disease Treated by Retransplantation |
| title_full_unstemmed | Posttransplantation Lymphoproliferative Disease Treated by Retransplantation |
| title_short | Posttransplantation Lymphoproliferative Disease Treated by Retransplantation |
| title_sort | posttransplantation lymphoproliferative disease treated by retransplantation |
| url | http://dx.doi.org/10.1155/2020/9403123 |
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