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  • Letter to the Editor
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Response to ‘Correlation between paraproteinaemia and viral reactivation after allo-SCT’

Bone Marrow Transplantation volume 47, page 1263 (2012)Cite this article

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We have previously reported a frequent occurrence of paraproteinaemia (monoclonal gammopathy) following allo-SCT. This finding was significantly associated with CMV reactivation in multivariate analysis.1 We did not routinely monitor EBV reactivation in our series, as this was not our practice at that time. The last allo-SCT in that series was performed in 2007, 2 years prior to the publication of the European Conference on Infections in Leukemia guidelines recommending routine EBV viral load monitoring following allo-SCT.2

Chiusolo et al.,3 cited by Metafuni et al.4 in their letter to the editor of this journal, also report a frequent detection of γ-region abnormalities on serum protein electrophoresis (SPE) following allo-SCT. These abnormalities were significantly more frequent in patients where SPE had been performed at the time of detection of EBV DNA in the peripheral blood, than in patients who did not experience EBV reactivation. SPE in this study was performed at the time of EBV detection for those patients with EBV reactivation, and at an unspecified time for those not reactivating EBV, rather than at pre-specified times for all patients in the study. In the light of this, no formal statistical correlation of the strength of the association between EBV reactivation and γ-region abnormalities could be made. Six patients in this study developed post-transplant lymphoproliferative disorder (PTLD), all had a γ-peak on SPE and 5/6 patients had a paraprotein detectable on immunofixation. These 6 PTLD patients, and another 12 with EBV viraemia received rituximab therapy. Following this treatment, the γ-peak disappeared in 3/4 patients with PTLD and in 9 patients with EBV viraemia, although a paraprotein remained detectable by immunofixation in 2/3 PTLD patients evaluated. Metafuni et al.4 suggested in their letter that this resolution of SPE abnormalities indicates a causal relationship between EBV reactivation and paraproteinaemia. We feel that, in the absence of control data, and considering that rituxumab will result in pan B-cell depletion and may therefore eradicate potential paraprotein producing clones not proliferating in response to EBV, these data cannot be used to support this conclusion.

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References

  1. Medd P, Littlewood S, Danby R, Malladi R, Clifford R, Wareham D et al. Paraproteinaemia after allo-SCT, association with alemtuzumab-based conditioning and CMV reactivation. Bone Marrow Transplant 2011; 46: 993–999.

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Author notes

  1. P G Medd

    Present address: Present address: Department of Haematology, University Hospital Southampton NHS Trust, Southampton General Hospital, Tremona Rd., Southampton, SO16 6YD, UK,

Authors and Affiliations

  1. Department of Haematology, Oxford University Hospitals NHS Trust, Cancer and Haematology Centre, Churchill Hospital, Oxford, UK

    P G Medd, A J Peniket & T J Littlewood

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  1. P G Medd
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  2. A J Peniket
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  3. T J Littlewood
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Correspondence to P G Medd.

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Medd, P., Peniket, A. & Littlewood, T. Response to ‘Correlation between paraproteinaemia and viral reactivation after allo-SCT’. Bone Marrow Transplant 47, 1263 (2012). https://doi.org/10.1038/bmt.2012.12

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