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Central nervous system post-transplant lymphoproliferative disorder despite negative serum and spinal fluid Epstein–Barr virus DNA PCR

Bone Marrow Transplantation volume 39, pages 249–251 (2007)Cite this article

Epstein–Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) is a rare complication following hematopoietic stem cell transplantation (HSCT) with an incidence of approximately 1%.1 Major risk factors for development of PTLD include unrelated or human leukocyte antigen (HLA)-mismatched-related donor transplantation, T-cell depletion of the graft, use of antithymocyte globulin (ATG), grade II–IV acute graft-versus-host disease (GVHD) and intense immunosuppression.2 Chronic GVHD is the main risk factor for late-onset PTLD.3 Isolated central nervous system (CNS) involvement with EBV-associated PTLD is an exceedingly rare complication after HSCT. We report here the development of isolated CNS PTLD, with negative-unfractionated whole blood and cerebrospinal fluid (CSF) EBV PCR, in a patient with chronic myeloid leukemia (CML) following a HLA-mismatched HSCT conditioned with busulfan, fludarabine and ATG.

A 49-year-old white man with CML, who progressed after 2 years of treatment with imatinib mesylate, entered accelerated phase while taking AMN107 (Nilotinib). He underwent nonmyeloablative peripheral blood HSCT from a two allele (HLA-B and HLA DRB1) mismatched unrelated female donor. Both donor and recipient were EBV positive. Following reduced-intensity conditioning with intravenous busulfan (0.8 mg/kg every 6 h, days −4 and −3), fludarabine (30 mg/m2/day, days −7, −6, −5, −4 and −3) and ATG (2.5 mg/kg/day, days −4, −3 and −2), 2.56 × 106 CD34+ cells/kg of recipient were infused. GVHD prophylaxis consisted of methotrexate (5 mg/m2 on days +1, +3, +6 and +11) and tacrolimus (starting day −2). The patient engrafted (ANC>500/mm3) on day +14 after the transplant. On day +23, the patient was started on prednisone (1 mg/kg/day) and mycophenolate mofetil for grade II acute GVHD. Engraftment studies (day +37) confirmed complete donor chimerism. The patient's immunosuppression was tapered to 10 mg prednisone daily and mycophenolate mofetil 500 mg daily by day +100.

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Authors and Affiliations

  1. Division of Hematology & Oncology, Arthur G. James Cancer Hospital, Ohio State University, Columbus, OH, USA

    M Hamadani, D M Benson, E A Copelan, S M Devine & C C Hofmeister

  2. College of Medicine, The Ohio State University, Columbus, OH, USA

    L K Martin

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  1. M Hamadani
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  2. L K Martin
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Correspondence to M Hamadani.

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Hamadani, M., Martin, L., Benson, D. et al. Central nervous system post-transplant lymphoproliferative disorder despite negative serum and spinal fluid Epstein–Barr virus DNA PCR. Bone Marrow Transplant 39, 249–251 (2007). https://doi.org/10.1038/sj.bmt.1705575

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