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T-cell lymphoproliferative disorder following a full haplotype-mismatched haematopoietic stem cell transplant in a patient with acute myeloid leukaemia

Bone Marrow Transplantation volume 36, pages 461–463 (2005)Cite this article

Post-transplant lymphoproliferative disorder (PTLD) is uncommonly of T-cell origin, especially following haematopoietic stem cell transplantation (HSCT). To date, only five cases have been reported. Four of these involved paediatric patients,1 and the remaining case reported by Yufu et al2 was of an adult patient who underwent autologous stem cell transplantation. Thus, our case is unique, being the first case reported of adult T-cell PTLD following a full haplotype-mismatched transplantation. Usually, PTLD is associated with EBV infection, and most are B-cell-type lymphomas. In PTLD, T-lymphocyte dysfunction caused by immunosuppressive treatment allows uncontrolled proliferation of B cells bearing the Epstein–Barr virus (EBV).3, 4 PTLD is considered rare (<1%) after allogeneic HSCT, but intensive immunosuppression, such as graft T-cell depletion, may markedly increase the risk of PTLD.1, 2, 4 The risk factors for PTLD development after allogeneic HSCT are: (1) T-cell depletion, (2) HLA-mismatching, (3) specific antilymphocyte therapy, and (4) primary immunodeficiency.1, 4 In the case of T-cell PTLD after HSCT, the situation may differ because there are very few cases available for study. In contrast, T-cell PTLD develops in 12–14% of solid organ transplants2 and about 38% are EBV-positive.3

The precise pathogenesis of T-cell PTLD is unknown. According to a report by Tatsuya et al,4 EBV can simultaneously infect B and T cells and can induce clonal proliferation of both lymphocyte subsets in individuals severely immunocompromised after allogeneic HSCT. Furthermore, a study in recipients of T-cell-depleted grafts suggested that an elevated EBV-DNA load was highly predictive for the development of EBV-PTLD.5 However, we unfortunately were unable to monitor EBV-DNA levels routinely.

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Acknowledgements

This study was supported in part by a grant of the National Cancer Control R&D Program 2003, Ministry of Health & Welfare, Republic of Korea.

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  1. Department of Internal Medicine, St Mary's Hospital, Catholic University of Korea College of Medicine, #62, Youido-dong, Youngdungpo-ku, Seoul, Seoul, 150-713, Korea, Korea

    C-K Rhee, J-H Rhee, H-J Kim, S-M Choi, Y-J Kim, D-W Kim, J-W Lee, W-S Min, W-S Shin & C-C Kim

  2. Catholic Hemopoietic Stem Cell Transplantation Center, St Mary's Hospital, Catholic University of Korea College of Medicine, #62, Youido-dong, Youngdungpo-ku, Seoul, Seoul, 150-713, Korea, Korea

    H-J Kim, S-M Choi, Y-J Kim, D-W Kim, J-W Lee, W-S Min, W-S Shin & C-C Kim

  3. Department of Radiology, St Mary's Hospital, Catholic University of Korea College of Medicine, #62, Youido-dong, Youngdungpo-ku, Seoul, Seoul, 150-713, Korea, Korea

    K-J Ahn

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Rhee, CK., Rhee, JH., Kim, HJ. et al. T-cell lymphoproliferative disorder following a full haplotype-mismatched haematopoietic stem cell transplant in a patient with acute myeloid leukaemia. Bone Marrow Transplant 36, 461–463 (2005). https://doi.org/10.1038/sj.bmt.1705068

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