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Post Transplant Lymphoproliferative Disorder

An unexpectedly high incidence of Epstein–Barr virus lymphoproliferative disease after CD34+ selected autologous peripheral blood stem cell transplant in neuroblastoma

Bone Marrow Transplantation volume 33, pages 651–657 (2004)Cite this article

Summary:

The risk of Epstein–Barr virus lymphoproliferative disease (EBV-LPD) increases with the use of highly immunosuppressive therapies. Allogeneic BMT, especially supported by T-cell-depleted stem cell products, is a risk factor for EBV-LPD. Although the risk of EBV-LPD after autologous transplantation is low, case reports of this complication in the autologous setting exist. We report a higher incidence than previously described of EBV-LPD in children undergoing sequential high-dose chemotherapy supported with CD34 selected peripheral blood stem cells (CD34+ PBSC). The median time to LPD after tandem transplant was 3 months (range 1–5 months). Five patients out of 156 (3.5%) developed EBV-LPD while enrolled on two trials of tandem autologous SCT in high-risk pediatric malignancies. Both studies employed five cycles of induction therapy, followed by tandem autologous PBSC transplants. In all, 108 out of 156 patients received CD34+ PBSC; 48 received unselected PBSC. All patients contracting LPD were from the CD34 selected group. Treatment of EBV-LPD included rituximab in four out of five patients, IVIg in two out of five patients, and gancyclovir in two out of five patients. EBV-LPD resolved in four out of five patients. We conclude that the combination of tandem SCT and CD34 selection may have increased immunosuppression in these patients to a point where there is an elevated risk of EBV-LPD.

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Authors and Affiliations

  1. Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA

    J L Powell, N J Bunin, C Callahan, R Aplenc & S A Grupp

  2. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    N J Bunin, R Aplenc & S A Grupp

  3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    R Aplenc

  4. A.I. Dupont Children's Hospital, Wilmington, DE, USA

    G Griffin

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  1. J L Powell
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Correspondence to S A Grupp.

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Powell, J., Bunin, N., Callahan, C. et al. An unexpectedly high incidence of Epstein–Barr virus lymphoproliferative disease after CD34+ selected autologous peripheral blood stem cell transplant in neuroblastoma. Bone Marrow Transplant 33, 651–657 (2004). https://doi.org/10.1038/sj.bmt.1704402

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