We report here a patient who developed multiple central nervous system (CNS) space-occupying lesions 6 months after bone marrow transplantation from an HLA-matched unrelated donor. He had extensive chronic graft-versus-host disease and severe thrombocytopenia. Posttransplantation lymphoproliferative disorder (PTLD) was diagnosed after biopsy of the lesion was facilitated by the transfusion of 40 units of platelets. Epstein-Barr virus (EBV) DNA was not initially detected in the peripheral blood by real-time polymerase chain reaction, and the blood became positive for EBV at a low level only after more than 6 weeks had passed since the initial identification of detectable intracranial lesions. The patient died of cerebral herniation while donor leukocyte infusion was being prepared, and an autopsy confirmed the diagnosis of EBV-associated PTLD restricted to the CNS.
Bone marrow transplantation Posttransplantation lymphoproliferative disorder Epstein-Barr virus Real-time PCR Central nervous system
This is a preview of subscription content, log in to check access.
Benkerrou M, Jais J, Leblond V, et al. Anti-B-cell monoclonal antibody treatment of severe posttransplant B-lymphoproliferative disorders: prognostic factors and long-term outcome.Blood. 1998; 92:3137–3147.PubMedPubMedCentralGoogle Scholar
Verschuur A, Brousse N, Raynal B, et al. Donor B cell lymphoma of the brain after allogeneic bone marrow transplantation for acute myeloid leukemia.Bone Marrow Transplant. 1994;14:467–470.PubMedPubMedCentralGoogle Scholar
Kimura H, Morita M, Yabuta Y, et al. Quantitative analysis of Epstein-Barr virus load by using a real-time PCR assay.J Clin Microbiol. 1999;37:132–136.PubMedPubMedCentralGoogle Scholar
Niesters HGM, Esser JV, Fries E, et al. Development of a real-time quantitative assay for detection of Epstein-Barr virus.J Clin Microbiol. 2000;38:712–715.PubMedPubMedCentralGoogle Scholar
Papadopoulos EB, Ladanyi M, Emanuel D, et al. Infusion of donor leukocytes to treat Epstein-Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation.N Engl J Med. 1994;330:1185–1191.CrossRefPubMedGoogle Scholar
Rooney CM, Smith CA, Ng CYC, et al. Infusion of cytotoxic T cells for the prevention and treatment of Epstein-Barr virus-associated lymphoma in allogeneic transplant recipients.Blood. 1998;92: 1549–1555.PubMedGoogle Scholar
Emanuel DJ, Lucas KG, Mallory GB, et al. Treatment of posttransplant lymphoproliferative disease in the central nervous system of a lung transplant recipient using allogeneic leukocytes.Transplantation. 1997;63:1691–1694.CrossRefPubMedGoogle Scholar
Davis KR, Hinrichs SH, Fidler JL, et al. Post-transplant Epstein-Barr virus-associated meningoencephalitis and lymphoid interstitial pneumonitis.Bone Marrow Transplant. 1999;24:443–444.CrossRefPubMedGoogle Scholar