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Complications Post Transplant

Epstein–Barr virus-associated B cell lymphoproliferative disorder following mismatched related T cell-depleted bone marrow transplantation

Bone Marrow Transplantation volume 28, pages 1117–1123 (2001)Cite this article

Abstract

Epstein–Barr virus (EBV) is closely associated with the progressive and often fatal lymphoproliferative disorders (LPD) in post bone marrow transplantation (BMT) and immunocompromised hosts. The incidence increases significantly when alternative donors or manipulation of marrow graft are used. A total of 318 consecutive BMT from partially mismatched related family donors (PMRD) were performed between February 1993 and June 1998. Known risk factors for the development of EBV-LPD were analyzed which included HLA mismatches, T cell depletion, antithymocyte globulin (ATG), and graft-versus-host disease (GVHD). Eighteen patients (5.7%) developed EBV-LPD at a median of 137 days post BMT (range 48–617). The estimated probability of developing EBV-LPD was 0.13 (95% CI 0.07–0.19) at 5 years. The incidence of grade II to IV GVHD was 19.2%, which translated into an increased trend of EBV-LPD. No correlation with other risk factors was observed. Treatment consisted of supportive antiviral agents, tapering of immunosuppressive regimens, donor leukocyte infusions and radiation. Three patients are alive and disease-free at a median follow-up of 69 months (range 36–71). We observed a lower than expected incidence of EBV-LPD despite existing multiple high-risk factors. We believe prevention and early control of GVHD may contribute to this finding.

Bone Marrow Transplantation (2001) 28, 1117–1123.

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Authors and Affiliations

  1. Children's Healthcare of Atlanta, Atlanta, GA, USA

    K-Y Chiang

  2. Vista Research, LLC, Columbia, SC, USA

    LJ Hazlett

  3. Oregon Health Sciences University, Portland, OR, USA

    KT Godder

  4. Oncology and Hematology Associates of Kansas City, Kansas City, MO, USA

    SH Abhyankar

  5. South Carolina Oncology Associates, Columbia, SC, USA

    NP Christiansen

  6. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    F van Rhee & RS Parrish

  7. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA

    CG Lee & K Bridges

  8. Indiana Blood and Marrow Transplantation, Indianapolis, IN, USA

    K Bridges

  9. Division of Transplantation Medicine, Palmetto Richland Memorial Hospital, South Carolina Cancer Center, University of South Carolina, Columbia, SC, USA

    PJ Henslee-Downey

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  1. K-Y Chiang
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  2. LJ Hazlett
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  4. SH Abhyankar
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  6. F van Rhee
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  10. PJ Henslee-Downey
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Chiang, KY., Hazlett, L., Godder, K. et al. Epstein–Barr virus-associated B cell lymphoproliferative disorder following mismatched related T cell-depleted bone marrow transplantation. Bone Marrow Transplant 28, 1117–1123 (2001). https://doi.org/10.1038/sj.bmt.1703311

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  • DOI: https://doi.org/10.1038/sj.bmt.1703311

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