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Shahid S, Rossi C, Vyas P, Bollard C, Dave H. Iatrogenic immunodeficiency-associated lymphoproliferative disorder in a child with B-cell acute lymphoblastic leukemia. Pediatr Hematol Oncol 2019; 36:309-316. [PMID: 31314679 DOI: 10.1080/08880018.2019.1637982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs) are a group of lymphoid proliferations or lymphomas that are well known to be associated with an immunosuppressed state. These disorders most commonly occur following hematopoietic or solid organ transplantation (called post-transplant lymphoproliferative disorders or PTLD), but cases have also been described during the treatment of autoimmune and rheumatologic disorders by immunosuppressive and immunomodulatory medications. These disorders are strongly associated with infection by the Epstein-Barr virus (EBV) as a result of impaired immune function in the immunosuppressed state. While this phenomenon has been well documented in autoimmune conditions, cases affecting pediatric patients while on anti-leukemia chemotherapy are lacking. In this report, we describe a case of a pediatric immunosuppressed patient with recurrent sinusitis found to have a nasopharyngeal mass consistent with EBV-positive B-cell lymphoproliferative disorder resembling a polymorphic PTLD during the maintenance phase of B-cell Acute Lymphoblastic Leukemia (ALL) therapy. The patient was successfully treated with rituximab without any cytotoxic chemotherapy, highlighting the importance of recognizing this clinical entity in non-transplant patients with hematologic malignancies.
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Affiliation(s)
- Sanam Shahid
- Children's National Health System , Washington , D.C
| | | | - Pranav Vyas
- Children's National Health System , Washington , D.C
| | | | - Hema Dave
- Children's National Health System , Washington , D.C
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2
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Lu BY, Kojima L, Huang MS, Friedmann AM, Ferry JA, Weinstein HJ. Facial manifestations of Epstein-Barr virus-related lymphoproliferative disease in childhood acute lymphoblastic leukemia in remission: Two atypical presentations. Pediatr Blood Cancer 2016; 63:2042-5. [PMID: 27392033 DOI: 10.1002/pbc.26102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/01/2016] [Accepted: 05/22/2016] [Indexed: 11/09/2022]
Abstract
Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) rarely occurs in patients with acute lymphoblastic leukemia (ALL), who have not received hematopoietic transplantation. We describe EBV-LPD manifesting as facial lesions in two children with ALL in remission. One patient was a 16-year-old male with T-cell ALL with an EBV-positive angiocentric polymorphous lip lesion presenting as right-sided facial swelling. The other patient was a 12-year-old male with B-cell ALL with an EBV-positive polymorphous lymphoplasmacytic infiltrate presenting as bilateral dacryoadenitis. Neither patient had known primary immunodeficiencies. Both cases improved with immunosuppressant de-escalation. These cases suggest that immunosuppression induced by maintenance chemotherapy is sufficient to promote EBV-LPD.
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Affiliation(s)
- Benjamin Y Lu
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Lisa Kojima
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mary S Huang
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Alison M Friedmann
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howard J Weinstein
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts.
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3
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Hussein MRA. Atypical lymphoid proliferations: the pathologist’s viewpoint. Expert Rev Hematol 2014; 6:139-53. [DOI: 10.1586/ehm.13.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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4
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Atabay B, Türker M, Oztürk C, Sütçüoğlu S, Oniz H, Ozer EA. Central nervous system involvement of epstein barr virus associated lymphoproliferative disorder in a child with acute lymphoblastic leukemia: successful treatment with rituximab and interferon-alpha. Turk J Haematol 2014; 30:58-62. [PMID: 24385755 PMCID: PMC3781665 DOI: 10.4274/tjh.2011.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/21/2012] [Indexed: 12/01/2022] Open
Abstract
Central nervous system (CNS) involvement of Epstein-Barr virus (EBV)-associated lymphoproliferative disease is a rare and serious complication in children with leukemia. Although rituximab therapy seems to be promising in these cases, persistent hypogammaglobulinemia may appear after treatment due to complete depletion of normal B lymphocytes in the peripheral blood. Here we report isolated CNS involvement of EBV-associated lymphoproliferative disorder in a 4-year-old boy with acute leukemia. The patient was treated with rituximab and interferon alpha; however, persistent hypogammaglobulinemia developed as a complication. Given the rarity of the complication in children receiving these agents, our experience with such a case may be helpful to others. Conflict of interest:None declared.
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Affiliation(s)
- Berna Atabay
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Meral Türker
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Can Oztürk
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Sümer Sütçüoğlu
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Haldun Oniz
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Esra Arun Ozer
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
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5
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Trottier H, Buteau C, Robitaille N, Duval M, Tucci M, Lacroix J, Alfieri C. Transfusion-related Epstein-Barr virus infection among stem cell transplant recipients: a retrospective cohort study in children. Transfusion 2012; 52:2653-63. [DOI: 10.1111/j.1537-2995.2012.03611.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Affiliation(s)
- Lode J. Swinnen
- Section Hematology/Oncology, Loyola University of Chicago, Maywood, IL and Hines VA Hospital, Hines, Illinois, USA
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7
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Nguyen-Van D, Ernberg I, Enrberg I, Phan-Thi Phi P, Tran-Thi C, Hu L. Epstein-Barr virus genetic variation in Vietnamese patients with nasopharyngeal carcinoma: full-length analysis of LMP1. Virus Genes 2008; 37:273-81. [PMID: 18663567 DOI: 10.1007/s11262-008-0262-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Genetic variation in tumor virus genes and its impact on function might contribute to the understanding of geographic differences in risks for virus-associated tumors. This is particularly true for the genes known to contribute to the biology of the tumor. It is has been proposed that Epstein-Barr virus (EBV) gene variation has a role in the high risk of nasopharyngeal carcinoma (NPC) in South-East Asia. NPC is among the five most common cancers in Vietnam. EBV-NPC cells always express EBV nuclear antigen 1 (EBNA1) and also frequently latent membrane protein 1 and 2 (LMP1 & LMP2). To investigate EBV gene variation in Vietnamese NPC patients we analyzed the full length of LMP1 gene including its promoter region, and the N-termini of both EBNA1 and LMP2A genes from five NPC biopsies. We detected two EBV variants V1 and V2 based on the LMP1 nucleotide sequence pattern compared with the prototype B95-8 and some available sequences including Chinese variants. The V1 variant shows strong similarity to a variant dominant in Southern China (China 1), while the V2 variant is similar to a Thai variant SEA 2 and partly identity with GD1 in the C-terminus. The promoter region and transmembrane domain of the SEA 2-like samples contained some specific differences compared with previously published variants. In contrast, analysis of EBNA1 N- and LMP2A N-termini only revealed minor changes. Our findings reinforces that the polymorphisms of whole LMP1 sequence should be considered in future EBV molecular epidemiology studies in different geographic populations.
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Affiliation(s)
- Do Nguyen-Van
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, P.O. Box 280, 171 77, Stockholm, Sweden.
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Wang IJ, Lu MY, Chiang BL, Lin WC, Lin DT, Lin KH. Epstein-Barr virus associated post-transplantation lymphoproliferative disorder with hemophagocytosis in a child with Wiskott-Aldrich syndrome. Pediatr Blood Cancer 2005; 45:340-3. [PMID: 15547918 DOI: 10.1002/pbc.20191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 23-month-old boy with Wiskott-Aldrich syndrome (WAS) received human leukocyte antigen (HLA)-one locus mismatched, unmanipulated allogeneic bone marrow graft from his mother. An Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder (PTLD) of donor cell origin and hemophagocytosis syndrome with fever, lymphadenopathy, hepatosplenomegaly, seizures, involuntary movements and pancytopenia developed 52 days after transplantation. It was difficult to decide on the treatment strategy because the patient presented with B-cell hyperplasia that morphologically appeared malignant but was oligoclonal by heavy-chain analyses. Despite of donor leukocyte transfusion, low dose chemotherapy, and anti-B cell monoclonal antibody immunotherapy, the patient died 107 days after transplantation.
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Affiliation(s)
- I Jen Wang
- Department of Pediatrics, Taipei Hospital, Taipei, Taiwan, Republic of China
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Drut R, Drut RM. Angiocentric immunoproliferative lesion and angiocentric lymphoma of lymph node in children. A report of two cases. J Clin Pathol 2005; 58:550-2. [PMID: 15858132 PMCID: PMC1770650 DOI: 10.1136/jcp.2004.022475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To report two examples of an angiocentric immunoproliferative lesion (AIL) and angiocentric angiodestructive lymphoma (AL) presenting in lymph nodes in children. Most commonly involving extranodal sites, AIL/AL rarely presents in the spleen and lymph nodes. METHODS/RESULTS Case 1 presented as a cervical lymphadenopathy in a 3 year old girl being treated for pre-B cell acute lymphoblastic leukaemia. Histological and immunohistochemistry studies revealed an Epstein-Barr virus positive (EBV+), large B cell (CD20 and CD30+) AIL with large areas of necrosis, the whole resembling lymphomatoid granulomatosis. Case 2 presented as a large supraclavicular lymphadenopathy in a 13 year old boy. Histology and immunohistochemistry revealed an EBV-, large T cell (CD45RO, CD56, and CD30+) AL, presenting the features of so called angiocentric T cell/natural killer cell lymphoma, nasal type. CONCLUSIONS The term AIL/AL refers to a heterogeneous group of conditions not unique to a particular type of lymphoid cell. These lesions are easily recognised by the histopathologist because of their extremely unusual angiocentric pattern. Although rare, AIL/AL may present as nodal lesions in children ab initio.
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Affiliation(s)
- R Drut
- Department of Pathology, Hospital de Niños Superiora Sor María Ludovica, 1900, La Plata, Argentina.
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10
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Sarkar C, Sharma MC, Deb P, Singh R, Santosh V, Shankar SK. Primary central nervous system lymphoma - A hospital based study of incidence and clinicopathological features from India (1983-2003). J Neurooncol 2005; 71:199-204. [PMID: 15690139 DOI: 10.1007/s11060-004-1385-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last two decades, an increase in the incidence of PCNSL cases has been reported in the West, both among immunosuppressed and immunocompetent patients. The present study was undertaken to assess the trend of incidence of PCNSL cases in India. To the best of our knowledge, only a single such report is available from India. All biopsy proven PCNSL cases obtained from the Neurosurgical databases of two large referral hospitals, one in Northern India (AIIMS, New Delhi) and another in Southern India (NIMHANS, Bangalore) from the period 1980 to 2003, were reviewed. Immunophenotyping was done and relevant clinical details collected. Appropriate statistical analysis was done to assess any change in trend of incidence or age at presentation. PCNSL cases constituted 0.95% and 0.92% of the total intracranial neoplasms at AIIMS and at NIMHANS, respectively. The mean age for cases diagnosed at AIIMS was 44.35 years, while that for NIMHANS was 39.51 years. Statistical analysis to evaluate any change in trend either of incidence or of age at presentation, over the study period, did not reveal any significant change. All the cases occurred in immunocompetent patients, except one case of HIV positive at NIMHANS, and one case of renal transplant at AIIMS. Frontal lobe was the most common site of involvement. Majority of the cases were diffuse, high grade, large cell lymphoma, B-cell immunophenotype. Thus, this multicentric hospital based study did not reveal any increase in incidence of PCNSL cases in India over the past 24 years. Further, in contrast to the West, majority of the cases in this Indian study were immunocompetent and a decade younger than in the West. The association of PCNSL with HIV/AIDS has been low in India, possibly due to early death in AIDS on account of opportunistic infections.
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Affiliation(s)
- Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Bangalore, India.
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11
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Szczepański T, de Vaan GAM, Beishuizen A, Bogman J, Jansen MWJC, van Wering ER, van Dongen JJM. Acute lymphoblastic leukemia followed by a clonally-unrelated EBV-positive non-Hodgkin lymphoma and a clonally-related myelomonocytic leukemia cutis. Pediatr Blood Cancer 2004; 42:343-9. [PMID: 14966831 DOI: 10.1002/pbc.10466] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Complicating malignant hematopoietic proliferations might severely hamper the course of acute lymphoblastic leukemia (ALL) in patients with an otherwise good prognosis. It is important to distinguish whether such neoplastic proliferations represent ALL relapses or secondary treatment-related malignancies. PROCEDURE We present an 11-year-old girl with precursor-B-ALL in whom maintenance treatment was complicated by an isolated ALL relapse in the brain, nodular lymphoproliferations in the liver, and an isolated myelo-monocytic leukemia cutis. All these hemato-oncologic malignancies occurred in the background of a secondary immunodeficiency, most likely caused by cytotoxic treatment. RESULTS AND CONCLUSIONS Using a stepwise molecular approach, we were able to demonstrate that the liver infiltrates were Epstein-Barr virus (EBV)-positive, contained monoclonal mature B-cells with immunoglobulin heavy chain gene (IGH) gene rearrangements unrelated to the primary ALL, and thus represented a true secondary non-Hodgkin lymphoma (NHL). In contrast, the skin infiltrates consisted of myelo-monocytic cells with clonal IGH and T-cell receptor gamma gene rearrangements, identical to the precursor-B-ALL blasts at diagnosis. Thus, the disease course of the precursor-B-ALL patient was complicated by two different isolated extramedullary relapses (brain and skin) and a secondary EBV(+) B-NHL.
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MESH Headings
- Child
- Clone Cells/pathology
- DNA, Viral/analysis
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Herpesvirus 4, Human/genetics
- Humans
- Leukemia/etiology
- Leukemia/pathology
- Leukemia, Myelomonocytic, Acute/etiology
- Leukemia, Myelomonocytic, Acute/pathology
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/pathology
- Neoplasms, Multiple Primary/etiology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
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Affiliation(s)
- Tomasz Szczepański
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Lehrnbecher T, Trusen A, Deinlein F, Höcht B, Marx A, Kühl J. B-Cell lymphoproliferative disorder not associated with Epstein-Barr Virus in a child with relapsed acute lymphoblastic leukemia. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:13-7. [PMID: 12426680 DOI: 10.1002/mpo.10202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lymphoproliferative disorder (LPD) is described in only a few children receiving chemotherapy for cancer. In all of them, an association between LPD and EBV (Epstein-Barr Virus) was found. We report on a patient who developed LPD not associated with EBV while receiving chemotherapy for relapsed acute lymphoblastic leukemia (ALL). Despite discontinuation of chemotherapy, administration of intravenous immunoglobulins and surgery the patient died. Growing experience with this disorder may allow better treatment options in the future and will show whether LPD not associated with EBV requires different therapeutic strategies.
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13
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Heath JA, Broxson EH, Dole MG, Filippa DA, George D, Lyden D, Dunkel IJ. Epstein-Barr virus-associated lymphoma in a child undergoing an autologous stem cell rescue. J Pediatr Hematol Oncol 2002; 24:160-3. [PMID: 11998794 DOI: 10.1097/00043426-200202000-00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD) is a serious disorder seen in various states of immunodeficiency, often with a fatal outcome. In this article, a patient with EBV-lymphoma after autologous stem cell rescue for treatment of a nonhematologic solid tumor is described. The child, a 4-year-old boy, had unilateral retinoblastoma with metastatic spread to the central nervous system. He had previously received both local tumor bed and craniospinal radiation therapy together with intensive myeloablative alkylator chemotherapy before autologous stem cell rescue. Histologically confirmed lymphoma with evidence of active EBV proliferation developed within cervical lymph nodes 3 weeks after his first autologous stem cell rescue. A complete clinical remission of the lymphadenopathy was obtained after infusions of rituximab (an anti-CD20 monoclonal antibody), acyclovir, and high-titer anticytomegalovirus immunoglobulin. The patient died approximately 6 months later of persistent and progressive retinoblastoma without any clinical evidence of lymphoma. It is concluded that EBV-LPD should be included in the differential diagnosis in patients in whom lymphadenopathy develops after autologous stem cell rescue.
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MESH Headings
- Acyclovir/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Carboplatin/administration & dosage
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/radiotherapy
- Central Nervous System Neoplasms/secondary
- Child, Preschool
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Disease Progression
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/drug therapy
- Etoposide/administration & dosage
- Eye Enucleation
- Eye Neoplasms/drug therapy
- Eye Neoplasms/pathology
- Eye Neoplasms/radiotherapy
- Eye Neoplasms/surgery
- Fatal Outcome
- Hematopoietic Stem Cell Transplantation
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunocompromised Host
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Immunotherapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Meningeal Neoplasms/drug therapy
- Meningeal Neoplasms/radiotherapy
- Meningeal Neoplasms/secondary
- Meningeal Neoplasms/therapy
- Methylprednisolone/therapeutic use
- Neoplasm Recurrence, Local
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/therapy
- Neoplasms, Second Primary/virology
- Optic Nerve Neoplasms/radiotherapy
- Optic Nerve Neoplasms/secondary
- Radiotherapy, Adjuvant
- Retinoblastoma/drug therapy
- Retinoblastoma/radiotherapy
- Retinoblastoma/secondary
- Retinoblastoma/surgery
- Retinoblastoma/therapy
- Rituximab
- Thiotepa/therapeutic use
- Vincristine/therapeutic use
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Affiliation(s)
- John A Heath
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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14
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Bernard F, Sarran N, Margueritte G, Barneon G, Astruc J. Successful treatment of an Epstein-Barr virus-associated B-cell lymphoproliferative disease in a child with acute lymphoblastic leukemia using an anti-CD20 monoclonal antibody. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 36:329-31. [PMID: 11452947 DOI: 10.1002/1096-911x(20010201)36:2<329::aid-mpo1077>3.0.co;2-f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- F Bernard
- Department of Pediatric, Hematology Oncology, Arnaud de Villeneuve Hospital, Montpellier, France.
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15
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Sung L, Dix D, Allen U, Weitzman S, Cutz E, Malkin D. Epstein-Barr virus-associated lymphoproliferative disorder in a child undergoing therapy for localized rhabdomyosarcoma. MEDICAL AND PEDIATRIC ONCOLOGY 2000; 34:358-60. [PMID: 10797360 DOI: 10.1002/(sici)1096-911x(200005)34:5<358::aid-mpo9>3.0.co;2-k] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L Sung
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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16
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Drury SS, Sathiapalan RK, Warrier RP. Central nervous system involvement of Epstein-Barr virus lymphoproliferative disease in a patient with acute lymphocytic leukemia. J Pediatr Hematol Oncol 2000; 22:167-70. [PMID: 10779033 DOI: 10.1097/00043426-200003000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) is a serious and often fatal complication of a variety of immune-suppressed conditions. A 6-year-old boy undergoing chemotherapy for standard-risk acute lymphocytic leukemia experienced separate episodes of EBV-LPD in different organ systems. The patient experienced three separate episodes of EBV-LPD in the cervical lymph node, the central nervous system (CNS), and the liver occurring, respectively, in January 1992, February 1992, and November 1993 after the completion of chemotherapy in May 1993. The EBV presence was confirmed by in situ hybridization in the biopsy samples from each lesion. Several different treatment modalities, including acyclovir, intravenous gamma globulin, and surgery were used to combat the EBV-LPD. The patient has recovered completely, with normal CNS and liver function, and for the past 6 years has experienced leukemia remission while not receiving chemotherapy. Careful monitoring of patients and the use of new immune therapies offer the highest chance for successful outcomes in such patients.
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Affiliation(s)
- S S Drury
- Department of Biometry and Genetics, Louisiana State University Medical Center, Children's Hospital of New Orleans, USA
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17
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Foran JM, Rohatiner AZS. Principles of diagnosis, staging and management. IMAGING 1999. [DOI: 10.1259/img.11.4.110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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18
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Norton AJ. The pathology of lymphoma. IMAGING 1999. [DOI: 10.1259/img.11.4.110201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Foran JM, Slater SE, Norton AJ, Wilkes SJ, Hart IJ, Rohatiner AZ. Monoclonal Epstein-Barr virus-related lymphoproliferative disorder following adult acute lymphoblastic leukaemia. Br J Haematol 1999; 106:713-6. [PMID: 10468862 DOI: 10.1046/j.1365-2141.1999.01593.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 31-year-old patient in remission of acute lymphoblastic leukaemia (ALL), receiving oral maintenance chemotherapy (6-mercaptopurine, methotrexate (MTX), cyclophosphamide), developed a monoclonal, Epstein-Barr virus (EBV)-related lymphoproliferative disorder (LPD). Treatment consisted of excisional biopsy and the discontinuation of maintenance chemotherapy. To our knowledge, this is the first such report in an adult. The histological similarity to previous reports of 'lymphomatoid granulomatosis' following paediatric ALL suggests that they are the same disease. MTX may play a central role in the development of LPD in this setting. Although it is a rare complication of ALL, EBV-related LPD should be considered in patients who develop lymphadenopathy.
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Affiliation(s)
- J M Foran
- Imperial Cancer Research Fund Medical Oncology Unit, St Bartholomew's Hospital, London.
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20
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Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation, with multiple factors being implicated in its pathogenesis. The clinical presentation of PTLD is atypical, therefore imaging and tissue biopsy are essential for diagnosis. Treatment requires drug combinations that are appropriate to the PTLD. Four patients with PTLD who had undergone orthotopic liver transplantation are documented, and their clinical characteristics and management described. These case histories identify neutropenia to be a problem and show that age does not seem to influence prognosis.
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Affiliation(s)
- P R Patel
- King's College School of Medicine and Dentistry, London, UK
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Perkkiö M, Riikonen P, Seuri R, Vornanen M. Successful treatment of monoclonal, aggressive Epstein-Barr virus-associated B-cell lymphoproliferative disorder in a child with acute lymphoblastic leukemia. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:447-9. [PMID: 10358706 DOI: 10.1002/(sici)1096-911x(199906)32:6<447::aid-mpo12>3.0.co;2-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M Perkkiö
- Department of Pediatrics, Kuopio University Hospital, Finland.
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22
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Gottesman SR, Haas D, Ladanyi M, Amorosi EL. Peripheral T cell lymphoma in a patient with common variable immunodeficiency disease: case report and literature review. Leuk Lymphoma 1999; 32:589-95. [PMID: 10048433 DOI: 10.3109/10428199909058418] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report documents the occurrence of a peripheral T cell lymphoma arising in the bone marrow and liver of a patient with common variable immunodeficiency disease. The T cell origin of this lymphoma was demonstrated by immunohistochemical phenotyping and gene rearrangement studies and was not associated with EBV infection of the lymphoma cells. The frequency and characteristics of lymphomas complicating CVID are reviewed.
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Affiliation(s)
- S R Gottesman
- Department of Pathology, SUNY Health Science Center at Brooklyn, NY 11203, USA
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24
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Jensen MK, Koch-Henriksen N, Johansen P, Varming K, Christiansen CB, Knudsen F. EBV-positive primary central nervous system lymphomas in monozygote twins with common variable immunodeficiency and suspected multiple sclerosis. Leuk Lymphoma 1997; 28:187-93. [PMID: 9498719 DOI: 10.3109/10428199709058346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Common variable immunodeficiency represents the most frequently occurring primary immunodeficiency disorder and is usually detected sporadically in patients with no family history of immunodeficiency. We present the case stories of two monozygote twins, who following a period of decreasing serum immunoglobulins developed primary central nervous system lymphomas. One twin had clinical and paraclinical features mimicking multiple sclerosis. Immunohistochemical investigations on biopsy tissue showed expression of the bcl-2 and p53 gene products, and Epstein-Barr virus (EBV) encoded small RNA's (EBER) indicating latent infection were detected in lymphoma cells using in situ hybridisation techniques. The pathogenetic role of EBV in oncogenesis is discussed.
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Affiliation(s)
- M K Jensen
- Dept. of Internal Medicine, Aalborg Hospital, Denmark
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26
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Abstract
Epstein Barr virus induced lymphoproliferative disease (EBV-LPD) is a heterogeneous disorder, ranging from polyclonal lymphoproliferations to malignant lymphoma, typically seen in individuals with inadequate cellular immunity to EBV. The diagnosis of EBV-LPD following transplant requires a high index of suspicion in those patients at risk. Unlike organ transplant patients, in whom lymphomas are generally of host origin and respond to decreases in immunosuppression, bone marrow transplant recipients have donor origin tumors that are not as responsive to conservative treatment modalities. For the latter group, adoptive immunotherapy with donor lymphocytes is the treatment of choice and generally results in complete eradication of these tumors. Whether adoptive immunotherapy can be used for EBV-LPD in patients following organ transplantation is currently being investigated.
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Affiliation(s)
- K G Lucas
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis 46202-5225, USA
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27
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Mustafa MM, Winick NJ, Margraf LR. Epstein-Barr virus lymphoproliferative disorder in children with leukemia: case report and review of the literature. J Pediatr Hematol Oncol 1997; 19:77-81. [PMID: 9065724 DOI: 10.1097/00043426-199701000-00012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study is to report a case of Epstein-Barr virus-related lymphoproliferative disorder (EBV-related LPD) in a child with leukemia and present a review of literature on the subject. PATIENTS AND METHODS A 6-year-old boy with acute lymphoblastic leukemia (ALL) undergoing maintenance chemotherapy presented with fever, abdominal pain, and vomiting. Imaging studies revealed multiple mass lesions in the liver, kidneys, and lungs. Liver biopsy was obtained. Immunocytochemistry for T and B lymphocytes and in situ hybridization for evidence of latent EBV infection was performed. RESULTS Hepatic portal tracts were infiltrated with lymphocytes, monocytes, eosinophils, and large atypical mononuclear cells. Both T and B lymphocytes were present, but the large atypical cells were of B origin and were positive for latent EBV infection. Chemotherapy was discontinued, and the patient was treated with intravenous gammaglobulin, interferon, and acyclovir. He had an excellent response and has been free of disease for 19 months. CONCLUSION EBV-related LPD can complicate the course of patients with ALL in remission. The clinical findings and diagnosis in patients with ALL are similar to other immunocompromised patients. Withdrawal of chemotherapy and treatment with immune modulators should be strongly considered.
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Affiliation(s)
- M M Mustafa
- Department of Pediatrics, University of Texas Southwestern Medical Center, U.S.A
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Oda D, Persson GR, Haigh WG, Sabath DE, Penn I, Aziz S. Oral presentation of posttransplantation lymphoproliferative disorders. An unusual manifestation. Transplantation 1996; 61:435-40. [PMID: 8610357 DOI: 10.1097/00007890-199602150-00021] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cyclosporine, an immunosuppressive agent widely used in organ transplantation, has several undesirable side effects, including gingival hyperplasia, which occurs in up to 70% of patients. Another complication associated with use of cyclosporine and other immunosuppressants is an increased incidence of malignancies. Long-term use of cyclosporine also is associated with a spectrum of hyperproliferative disorders ranging from reactive lymphoid hyperplasia to aggressive malignant lymphomas. While cyclosporine-related lymphoproliferative disorders have been widely reported, they have not been described in the oral cavity as the first manifestation of this disease. We report on two cardiac transplantation patients with a history of cyclosporine use who presented initially with oral symptoms of lymphoproliferative disorder. Both had erythematous to cyanotic and hyperplastic gingiva. On gingivectomy, the fixed tissue was soft, glistening, and tan colored, in contrast to the usual firm, white, cyclosporine-associated, benign gingival fibrous hyperplasia. Histologically, a dense, diffuse infiltrate of lymphoplasmacytoid cells with vesicular nuclei, prominent nucleoli, a moderate amount of cytoplasm, and high mitotic activity was observed. Immunocytochemical studies confirmed that the cells were monoclonal for lambda light chains in one patient and kappa light chains in the other. The cells from one patient were positive for CD45, while both patients were negative for CD20 and all nonhematopoietic antigens tested. Both tissues were strongly positive for Epstein-Barr virus. Morphology and immunocytochemistry findings are consistent with a posttransplant lymphoproliferative disorder. These are the first two reported cases of cyclosporine-associated posttransplant lymphoproliferative disorders presenting as gingival hyperplasia.
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Affiliation(s)
- D Oda
- Department of Oral Biology, School of Dentistry, University of Washington, Seattle 98195, USA
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29
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Morrison VA, Dunn DL, Manivel JC, Gajl-Peczalska KJ, Peterson BA. Clinical characteristics of post-transplant lymphoproliferative disorders. Am J Med 1994; 97:14-24. [PMID: 8030652 DOI: 10.1016/0002-9343(94)90043-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To study the histopathologic findings, clinical course, and therapeutic outcome of patients who developed a lymphoproliferative disorder after undergoing solid organ transplantation. PATIENTS AND METHODS A series of 26 patients who developed a lymphoproliferative disorder after solid organ transplant during a 27-year period were studied. RESULTS The 26 patients ranged in age from 6 to 68 years (median 42 years). The lymphoproliferative disorder was diagnosed from 1 to 211 months (median 80 months) after transplantation. The type of transplant was kidney (n = 21), heart or heart-lung (n = 4), or liver (n = 1). Most patients received azathioprine and prednisone, in addition to antilymphocyte globulin or cyclosporine, for post-transplant immunosuppression. Eight patients had lymphoma that could be classified according to the International Working Formulation (IWF-F, IWF-G, IWF-H). Sixteen patients had polymorphic lymphoma, and 2 patients were classified as having polymorphic lymphoid hyperplasia. Patients were staged by the Ann Arbor staging system. Nine patients had stage I disease, 4 stage II, 6 stage III, and 7 stage IV. Central nervous system, lung, or marrow involvement was present in 27%, 23%, and 14% of patients, respectively. In the 17 patients studied, immunophenotype was monoclonal B-cell (n = 12), malignant T-cell (n = 2), or polyclonal B-cell (n = 3). The initial therapeutic approach was generally a reduction in immunosuppression, but, thereafter, the approach to therapy varied. In patients with localized disease, surgical excision and/or involved field radiotherapy were utilized as applicable. For patients with more extensive disease, other approaches such as high-dose acyclovir, combination chemotherapy, or alpha interferon were utilized. Overall, 15 of 26 patients (58%) responded to systemic therapy or were rendered disease-free either by surgery or radiation, including 8 (31%) with a complete remission (CR). Only 3 of 9 patients responded to chemotherapy, whereas 4 of 13 patients responded to acyclovir (including 3 patients who experienced CR). Remission duration ranged from 8 to 122 months (median 32+ months). Twenty-one of 26 patients (81%) have died. Survival ranged from less than 1 to 122 months (median 14 months). CONCLUSION The outcome of patients with post-solid organ transplant lymphoproliferative disorders is poor, and the optimal approach to therapy is not clear. Newer therapeutic approaches are thus needed to improve the outcome of these patients.
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Affiliation(s)
- V A Morrison
- Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis
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30
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Itoyama T, Sadamori N, Tsutsumi K, Tokunaga Y, Soda H, Tomonaga M, Yamamori S, Masuda Y, Oshima K, Kikuchi M. Primary central nervous system lymphomas. Immunophenotypic, virologic, and cytogenetic findings of three patients without immune defects. Cancer 1994; 73:455-63. [PMID: 8293413 DOI: 10.1002/1097-0142(19940115)73:2<455::aid-cncr2820730234>3.0.co;2-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Primary central nervous system (PCNS) lymphoma is a relatively rare disease, but an increasing incidence is reported. The Epstein-Barr virus (EBV), which is often found in lymphomas of immunocompromised patients, has been implicated in the development of lymphomas. Many cytogenetic analyses of nodal B cell lymphomas have been performed, but few studies on PCNS lymphomas have been reported. METHODS The detection of EBV genome using the polymerase chain reaction (PCR) method and cytogenetic studies were performed, in addition to histopathologic and immunophenotypic approaches in biopsied tissue from three patients with PCNS lymphoma. Immunosuppressive states and exposure to mutagens were not clear in all patients. RESULTS Histopathologic examination disclosed a diffuse type of malignant lymphoma in all patients. Immunophenotypic studies revealed B cell phenotype in all patients, two of whom showed positive reaction for CD5. The PCR method revealed no involvement of EBV genome in tumors in any patients. The cytogenetic study showed clonal chromosome abnormalities in all patients, and abnormalities of chromosome 1 (1q21), 6 (-6, 6q15 and 6q21), 7 (-7 and 7p15), and 14 (14q24 and 14q32) were prominent. The t(6;14)(q15;q32) observed in Patient 1 is the first case to be reported in human de novo lymphoma. CONCLUSIONS These findings indicate that the causative role of EBV in PCNS lymphoma without immune defects is not clear. The cytogenetic findings were similar to those observed in nodal B-cell lymphoma, suggesting that the origin of PCNS lymphoma cells does not differ from nodal B cell lymphoma cells cytogenetically.
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MESH Headings
- Aged
- Base Sequence
- Brain Neoplasms/genetics
- Brain Neoplasms/microbiology
- Chromosome Aberrations
- Genome, Viral
- Herpesvirus 4, Human/genetics
- Humans
- Immunophenotyping
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large-Cell, Immunoblastic/genetics
- Lymphoma, Large-Cell, Immunoblastic/microbiology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/microbiology
- Male
- Middle Aged
- Molecular Sequence Data
- Polymerase Chain Reaction
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Affiliation(s)
- T Itoyama
- Department of Hematology, Nagasaki University School of Medicine, Japan
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Trimble MS, Waye JS, Walker IR, Brain MC, Leber BF. B-cell lymphoma of recipient origin 9 years after allogeneic bone marrow transplantation for T-cell acute lymphoblastic leukaemia. Br J Haematol 1993; 85:99-102. [PMID: 8251416 DOI: 10.1111/j.1365-2141.1993.tb08651.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 25-year-old woman developed an immunoblastic lymphoma 9 years after HLA-identical allogeneic bone marrow transplantation for T-cell acute lymphoblastic leukaemia in second remission. The B-cell origin of the second malignancy was confirmed by gene rearrangement studies. Despite continued donor engraftment, two separate genotypic analyses identified the lymphoma to be of recipient origin. This is the longest latency of a post-transplant recipient lymphoma yet reported and illustrates that recipient B-cells may survive the transplant conditioning regimen and undergo malignant transformation in the presence of donor haemopoiesis.
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Affiliation(s)
- M S Trimble
- Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Affiliation(s)
- L J Swinnen
- Loyola University Chicago, Maywood, IL 60153
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33
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Abstract
The Wiskott-Aldrich syndrome is an uncommon X-linked recessive disease characterized by eczema, thrombocytopenia, and immunodeficiency. The clinical features begin early in life and include recurrent infections, bleeding, and severe eczema. Unless the condition is treated by bone marrow transplantation, the prognosis of Wiskott-Aldrich syndrome is grave, and premature death caused by sepsis, hemorrhage, or lymphoreticular malignancy is common. Although the biochemical defect responsible for the syndrome is not known, recent investigations with restriction fragment length polymorphisms have mapped the Wiskott-Aldrich syndrome locus to the proximal portion of the short arm of the human X chromosome (Xp11). The isolation of these DNA markers makes feasible both carrier detection and prenatal diagnosis of Wiskott-Aldrich syndrome and provides an important adjunct to the management of Wiskott-Aldrich syndrome for patients and their families. These genetic data, in conjunction with the recent identification of a specific O-glycosylation defect in lymphocytes from patients with Wiskott-Aldrich syndrome, present an opportunity for the eventual isolation of the Wiskott-Aldrich syndrome gene and identification of the underlying cellular defect. We review the clinical and laboratory features of this syndrome and summarize the new molecular and biochemical approaches that can be used in diagnosis, genetic counseling, and treatment.
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Affiliation(s)
- M Peacocke
- Department of Dermatology, New England Medical Center, Boston, MA 02111
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Simon M, Bartram CR, Friedrich W, Arnold R, Schmeiser T, Hampl W, Müller-Hermelink HK, Heymer B. Fatal B-cell lymphoproliferative syndrome in allogeneic marrow graft recipients. A clinical, immunobiological and pathological study. VIRCHOWS ARCHIV. B, CELL PATHOLOGY INCLUDING MOLECULAR PATHOLOGY 1991; 60:307-19. [PMID: 1685038 DOI: 10.1007/bf02899562] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have studied four cases of fatal B-cell lymphoproliferative syndrome (LPS) developing among 333 patients (incidence 1.2%) treated with allogeneic bone marrow transplantation (BMT). All four patients had received a T-cell depleted graft. Onset of the first clinical symptoms (palpable lymph node enlargement in three and IgA-lambda paraproteinemia in two patients) occurred between 41 and 188 days post-BMT (median 76 days). The course of the LPS was rapidly progressive in all cases, leading to death in 2-5 weeks. The peripheral blood showed progressive pancytopenia with disproportionally high numbers of activated NK cells, apparently compensating for the T-cell deficiency. Post-mortem histological studies disclosed polymorphic B-cell proliferations, most pronounced in the lymph nodes, spleen, liver, lungs and kidneys. Lymphohemopoietic cells were of donor origin in three patients. In the fourth patient, graft failure suggested a host origin for the proliferating cells. Immunophenotyping and gene rearrangement analysis revealed polyclonal proliferation in one patient, monoclonal proliferation in another patient, and an oligoclonal pattern in the other two patients. The clinical behavior of the LPS was independent of clonality. Immunohistologically, the proliferating cells showed characteristics of relatively mature B-cells in three cases, and pre-B-cell features in one case. Epstein Barr virus (EBV) serology indicated seroconversion (primary infection) in one child, and chronic active EBV infection in both adults. EBV DNA as well as EBV nuclear antigen (EBNA) were detected in infiltrated tissues of all four patients. The labeling pattern on in situ hybridization suggested a replicative EBV infection comparable to that in lymphoblastoid cell lines. We conclude that EBV-associated LPS developing as a result of post-transplant immunodeficiency is a distinct clinicopathologic entity, differing from non-Hodgkin's lymphoma (including Burkitt's lymphoma) and infectious mononucleosis of the immunocompetent host.
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Affiliation(s)
- M Simon
- Department of Pathology, University of Ulm, Federal Republic of Germany
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35
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Nalesnik MA. Lymphoproliferative disease in organ transplant recipients. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1991; 13:199-216. [PMID: 1664986 DOI: 10.1007/bf00201469] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M A Nalesnik
- Department of Pathology, University of Pittsburgh Medical Center, PA 1513
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The diagnosis of Epstein-Barr virus-associated polymorphic B cell lymphoma in immunocompromised patients: Review of methods. Can J Infect Dis 1991; 2:109-15. [PMID: 22529719 DOI: 10.1155/1991/961759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/1990] [Accepted: 12/15/1990] [Indexed: 11/18/2022] Open
Abstract
Polymorphic B cell lymphoma and diffuse B cell lymphoproliferation associated with Epstein-Barr virus infection is increasingly reported in immunodeficient patients. Accurate diagnosis of these pathologies is essential because the appropriate treatment regimens for the patients in question differ from those for patients with other lymphoproliferative diseases. Two complementary techniques are currently used in the diagnosis and characterization of Epstein-Barr virus-associated B cell lymphomas and diffuse B cell lymphoproliferation. Immunofluorescence allows specific detection of Epstein-Barr nuclear antigens in lymphomatous tissue. Molecular hybridization with the Bam H1-W and/or Bam H1-NJ probes confirms the presence of the Epstein-Barr virus genome in tumour cells. The Bam H1-NJ probe is also useful in determining the clonality of the tumour and the replication mode, episomal or linear, of the viral genome. The polymerase chain reaction method allows detection of the Epstein-Barr virus genome within 24 h in these tumours and is more sensitive.
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Abstract
The non-Hodgkin's lymphomas are a group of diseases for which substantial progress has been made in understanding tumor biology and effectiveness of treatment during the last decade. These advances may provide insight into the development of neoplasms because of recognized association of lymphomas with viral infections and immunodeficiency. The prognosis for patients with NHL continues to improve. As a result, current studies on treatment of lymphomas in certain favorable stages have concentrated on reducing the intensity of therapy. For patients with advanced disease, further improvements in treatment are still being sought.
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Affiliation(s)
- J Kurtzberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Swinnen LJ, Costanzo-Nordin MR, Fisher SG, O'Sullivan EJ, Johnson MR, Heroux AL, Dizikes GJ, Pifarre R, Fisher RI. Increased incidence of lymphoproliferative disorder after immunosuppression with the monoclonal antibody OKT3 in cardiac-transplant recipients. N Engl J Med 1990; 323:1723-8. [PMID: 2100991 DOI: 10.1056/nejm199012203232502] [Citation(s) in RCA: 722] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A sudden increase in the incidence of post-transplantation lymphoproliferative disorder among the patients in our cardiac-transplantation program was temporally related to introduction of the immunosuppressive drug OKT3. This monoclonal antibody has come to be widely used in recent years both to prevent and to treat rejection after cardiac transplantation. METHODS In order to identify variables that predict the development of post-transplantation lymphoproliferative disorder, we analyzed retrospectively a series of 154 consecutive cardiac-transplant recipients at a single institution. Univariate analyses and multivariate analysis by logistic regression were performed. RESULTS Among 75 patients who did not receive OKT3, post-transplantation lymphoproliferative disorder developed in 1 (1.3 percent), as compared with 9 of 79 patients who received the drug (11.4 percent); the incidence among the OKT3-treated patients was ninefold higher (odds ratio, 9.5; 95 percent confidence interval, 1.6 to 54.7). According to multivariate analysis, the only factor significantly associated with the development of post-transplantation lymphoproliferative disorder was the use of OKT3 (P = 0.001). A significant increase in risk with increasing doses was also apparent: 4 of 65 patients who received a cumulative dose of 75 mg of OKT3 or less (6.2 percent) had post-transplantation lymphoproliferative disorder, whereas 5 of 14 patients who received more than 75 mg had the disorder (35.7 percent; P less than 0.001). CONCLUSION The addition of OKT3 to the immunosuppressive regimen increases the incidence of post-transplantation lymphoproliferative disorder after cardiac transplantation, and the risk increases sharply after cumulative doses greater than 75 mg. We suggest that the risks and benefits of prophylactic OKT3 administration be reassessed in the light of these findings, particularly since the value of prophylactic immunotherapy in cardiac-transplant recipients remains to be clearly established.
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Affiliation(s)
- L J Swinnen
- Department of Medicine, Loyola University of Chicago, Maywood, Ill
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Michalski A, Radley-Smith R, Crawford D. Non-Hodgkin's lymphoma in a cardiac transplant patient--successful management without chemotherapy. MEDICAL AND PEDIATRIC ONCOLOGY 1990; 18:503-9. [PMID: 2233524 DOI: 10.1002/mpo.2950180613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Michalski
- Department of Haematology Hospital for Sick Children, London
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