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:

EBV-associated post transplant lymphoproliferative disorder of the ‘loser’ graft cell origin following double unrelated umbilical cord blood transplantation

Bone Marrow Transplantation volume 44, pages 193–195 (2009)Cite this article

Post transplant lymphoproliferative disorders (PTLD) are life-threatening complications of hematopoietic SCT as well as organ transplantation, caused by EBV-driven B-cell growth combined with defective T-cell immunity.1 PTLD mostly occurs during the first 6 months after hematopoietic SCT and originates from the donor cell compartment; however, PTLD pathogenesis is not completely understood.2 PTLD appears to be at increasing risk after umbilical cord blood unrelated transplants (UCBT), mainly due to the graft immunoincompetence and slow engraftment, as well as to the use of antithymocyte globuline (ATG) in the preparative regimens.3 Double UCBT is an emerging procedure aiming to increase the number of infused cells, widening UCBT application to the adult population.4 Here, we describe the characteristics of an EBV–PTLD of the ungrafted donor cell origin, with very early onset after double UCBT, in an adult patient.

A 23-year-old man with severe aplastic anemia, polytransfused and treated with immunosuppressive chemotherapy for 3 years, was transplanted in September 2006, with two unrelated UCB units (UCB-1 and UCB-2), both female, from the National Cord Blood Program, New York, USA. Grafts were five/six HLA-matched (UCB-1 and 2, A- and C-mismatched, respectively) and were sequentially infused, with CD34+cell doses of 0.16 × 106/kg (total 9.7 × 106) for UCB-1 and 0.09 × 106/kg (total 5.2 × 106) for UCB-2.

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

Figure 1
Figure 2

References

  1. Gottschalk S, Rooney CM, Heslop H . Post-transplant lymphoproliferative disorders. Annu Rev Med 2005; 56: 29–44.

    Article  CAS  PubMed  Google Scholar 

  2. Hopwood P, Crawford DH . The role of EBV in post-transplant malignancies: a review. J Clin Pathol 2000; 53: 248–254.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Brunstein CG, Weisdorf DJ, DeFor T, Barker JN, Tolar J, van Burik J-AH 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 

  4. Ballen KK, Spitzer TR, Yeap BY, McAfee S, Dey BR, Attar E et al. Double unrelated reduced-intensity umbilical cord blood transplantation in adults. Biol Blood Marrow Transplant 2007; 13: 82–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hassan R, Bonamino M, Braggio E, Lobo A, Seuanez H, Tabak D et al. A systematic approach to molecular quantitative determination of mixed chimaerism after allogeneic bone marrow transplantation: an analysis of its applicability in a group of severe aplastic anemia patients. Eur J Haematol 2004; 73: 156–161.

    Article  PubMed  Google Scholar 

  6. Hassan R, White L, Stefanoff CG, de Oliveira DE, Felisbino FE, Klumb CE et al. Epstein-Barr Virus (EBV) detection and typing by PCR: a contribution to diagnostic screening of EBV-positive Burkitt's lymphoma. Diagn Pathol 2006; 1: 17.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Niesters HG, van Esser J, Fries E, Wolthers KC, Cornelissen J, Osterhaus AD . Development of a real-time quantitative assay for detection of Epstein-Barr virus. J Clin Microbiol 2000; 38: 712–715.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Reddiconto G, Chiusolo P, Fiorini A, Farina G, Laurenti L, Martini M et al. Assessment of cellular origin and EBV status in a PTLD after double cord blood transplantation. Leukemia 2007; 21: 2552–2554.

    Article  CAS  PubMed  Google Scholar 

  9. Haut PR, Kovarik P, Shaw PH, Walterhouse D, Jenson HB, Kletzel M . Detection of EBV DNA in the cord blood donor for a patient developing Epstein-Barr virus-associated lymphoproliferative disorder following mismatched unrelated umbilical cord blood transplantation. Bone Marrow Transplant 2001; 27: 761–765.

    Article  CAS  PubMed  Google Scholar 

  10. van Esser JW, Niesters HG, van der Holt B, Meijer E, Osterhaus AD, Gratama JW et al. Prevention of Epstein-Barr virus lymphoproliferative disease by molecular monitoring and preemptive rituximab in high-risk patients after allogeneic stem cell transplantation. Blood 2002; 99: 4364–4369.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by SwissBridge Foundation (Switzerland), and by the Brazilian public financial agencies Fundação de Amparo à Pesquisa do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Author information

Authors and Affiliations

  1. Bone Marrow Transplantation Center (CEMO), Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil

    R Hassan, C G Stefanoff, S Maradei, G A Fernandes, M H M Barros, F N Carestiato, L F Bouzas & I R Zalcberg

  2. Departamento Integrado de Patologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil. E-mail: biomol@inca.gov.br,

    S O Romano

Authors
  1. R Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C G Stefanoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Maradei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G A Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M H M Barros
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F N Carestiato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S O Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L F Bouzas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I R Zalcberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supplementary Information accompanies the paper on Bone Marrow Transplantation website (http://www.nature.com/bmt)

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hassan, R., Stefanoff, C., Maradei, S. et al. EBV-associated post transplant lymphoproliferative disorder of the ‘loser’ graft cell origin following double unrelated umbilical cord blood transplantation. Bone Marrow Transplant 44, 193–195 (2009). https://doi.org/10.1038/bmt.2008.445

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2008.445

Search

Advanced search

Quick links