Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Post-transplant lymphoproliferative disease following reduced intensity conditioning transplants incorporating alemtuzumab

Bone Marrow Transplantation volume 42, pages 281–282 (2008)Cite this article

The development of EBV-driven B-cell lymphoproliferative disorders following allogeneic haemopoietic stem cell transplantation is a serious and well recognised complication occurring with an incidence of 0.6–26%.1 Higher incidences occur in the context of T-cell depleted transplants; other risk factors include the use of unrelated and mismatched donors and the use of anti thymocyte globulin (ATG) or anti-CD3 as part of the preparative regimen. In contrast, Campath antibodies (1G or 1H) deplete both T and B cells2 thus avoiding the selective depletion of T cells.

In recent years there has been an increasing number of allografts performed using non-myeloablative or reduced intensity (RIC) conditioning regimens. Early evidence suggests that the increased immunosuppression with RIC allografts may be associated with a high risk of EBV reactivation and post-transplant lymphoproliferate disease (PTLD) especially when they involve ATG administration. In the UK many of these highly immunosuppressive RIC protocols incorporate Alemtuzumab (Campath 1H). The exact dose of Alemtuzumab required for optimal engraftment and immune reconstitution while preventing GVHD and preserving GVL effects is unknown. Hence, several groups including ours have been interested in exploring Alemtuzumab dose reduction and its effect on these parameters. Here, we report an unexpectedly high incidence of PTLD observed following a reduction in Campath total dose from 50 to 30 mg. Details of the three cases of PTLD out of six RIC allografts with reduced dose of Alemtuzumab of 30 mg are given in Table 1.

Table 1 Details of the three cases of PTLD out of six RIC allografts performed with reduced dose of Alemtuzumab
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Micallef IN, Chhanabhai M, Gascoyne RD, Shepherd JD, Fung HC, Nantel SH et al. Lymphoproliferative disorders following allogeneic bone marrow transplantation: the Vancouver experience. Bone Marrow Transplant 1998; 22: 981–987.

    Article  CAS  PubMed  Google Scholar 

  2. Hale G, Jacobs P, Wood L, Fibbe WE, Barge R, Novitzky N et al. CD52 antibodies for prevention of graft-versus-host disease and graft rejection following transplantation of allogeneic peripheral blood stem cells. Bone Marrow Transplant 2000; 26: 69–76.

    Article  CAS  PubMed  Google Scholar 

  3. Cohen JM, Cooper N, Chakrabarti S, Thomson K, Samarasinghe S, Cubitt D et al. EBV-related disease following haematopoietic stem cell transplantation with reduced intensity conditioning. Leuk Lymphoma 2007; 48: 256–269.

    Article  PubMed  Google Scholar 

  4. Brunstein CG, Weisdorf DJ, DeFor T, Barker JN, Tolar J, van Burik JA et al. Marked increased risk of Epstein-Barr virus-related complications with the addition of antithymocyte globulin to a nonmyeloablative conditioning prior to unrelated umbilical cord blood transplantation. Blood 2006; 108: 2874–2880.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hale G, Waldmann H . Risks of developing Epstein–Barr virus-related lymphoproliferative disorders after T-cell-depleted marrow transplants. CAMPATH Users. Blood 1998; 91: 3079–3083.

    CAS  PubMed  Google Scholar 

  6. Gazitt Y, Or R, Mumcuoglu M, Slavin S . Monoclonal rat anti-human lymphocyte antibody Campath-1 binds to T and B lymphocytes but effectively lyses only T cells. Bone Marrow Transplant 1987; 2: 427–433.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Haematology, Nottingham University Hospitals-City Hospital Campus, Nottingham, UK

    S W Bokhari, E Das-Gupta, N H Russell & J Byrne

Authors
  1. S W Bokhari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E Das-Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N H Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S W Bokhari.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bokhari, S., Das-Gupta, E., Russell, N. et al. Post-transplant lymphoproliferative disease following reduced intensity conditioning transplants incorporating alemtuzumab. Bone Marrow Transplant 42, 281–282 (2008). https://doi.org/10.1038/bmt.2008.149

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2008.149

This article is cited by

Search

Advanced search

Quick links