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Treatment of rare co-occurrence of Epstein-Barr virus-driven post-transplant lymphoproliferative disorder and hemophagocytic lymphohistiocytosis after allogeneic stem cell transplantation.
Weber, T; Wickenhauser, C; Monecke, A; Gläser, C; Stadler, M; Desole, M; Ligeti, K; Behrmann, C; Müller-Tidow, C; Müller, L P.
Affiliation
  • Weber T; Department of Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Transpl Infect Dis ; 16(6): 988-92, 2014 Dec.
Article in En | MEDLINE | ID: mdl-25179757
In both conditions, post-transplant lymphoproliferative disorder (PTLD) and hemophagocytic lymphohistiocytosis (HLH), infection with Epstein-Barr virus (EBV) is a key mechanism: almost all PTLD in allogeneic stem cell transplantation (alloSCT) is caused by EBV-related neoplastic lymphoproliferation, and secondary HLH is most frequently triggered by EBV infection. Therefore, concomitant EBV-driven PTLD and HLH early after alloSCT require an approach to eliminate EBV and balance immune activation simultaneously. We report on a patient who developed simultaneous PTLD and signs of HLH on day 64 after alloSCT. Treatment was comprised of stopping cyclosporine, short-course dexamethasone, and 3 courses of rituximab. The patient showed full recovery and complete remission of lymphadenopathy. This result indicates that immediate reduction in EBV-carrying B cells by rituximab, suppression of general inflammation, and parallel support of reconstitution of long-term T-cell function, might be an appropriate therapeutic approach in this rare situation.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Epstein-Barr Virus Infections / Stem Cell Transplantation / Lymphohistiocytosis, Hemophagocytic / Lymphoproliferative Disorders Limits: Adult / Humans / Male Language: En Journal: Transpl Infect Dis Journal subject: TRANSPLANTE Year: 2014 Document type: Article Affiliation country: Germany Country of publication: Denmark

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Epstein-Barr Virus Infections / Stem Cell Transplantation / Lymphohistiocytosis, Hemophagocytic / Lymphoproliferative Disorders Limits: Adult / Humans / Male Language: En Journal: Transpl Infect Dis Journal subject: TRANSPLANTE Year: 2014 Document type: Article Affiliation country: Germany Country of publication: Denmark