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Discrepancy in EBV-DNA load between peripheral blood and cerebrospinal fluid in a patient with isolated CNS post-transplant lymphoproliferative disorder

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Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of allogeneic hematopoietic stem cell transplantation (HSCT) that is caused by reactivation of Epstein–Barr virus (EBV). A successful approach, monitoring EBV-DNA load in peripheral blood (PB) accompanied by preemptive rituximab therapy, has recently been reported. Here, we describe a 29-year-old woman who developed isolated central nervous system (CNS) PTLD. She received HSCT against acute myelogenous leukemia from a related human leukocyte antigen-haploidentical donor, following a conditioning regimen that included antithymocyte globulin. Tacrolimus and methylprednisolone were given as prophylaxis for graft-versus-host disease. On day +172, the patient’s consciousness deteriorated. Magnetic resonance imaging showed six ring-enhanced lesions in the cerebral hemispheres. These tumors were diagnosed, via a craniotomy and tumorectomy, as PTLD. EBV-DNA load was elevated in the cerebrospinal fluid (CSF) but not detected in PB. She was treated with whole-brain irradiation and rituximab, and achieved partial remission of the tumors. This case serves as a reminder that vigilance is required regarding the development of isolated CNS PTLD; it is worth examining EBV-DNA replication in CSF for diagnosis even when the EBV-DNA load is negative in PB.

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Conflict of interest

The authors declare no competing financial interest.

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Authors and Affiliations

  1. Department of Hematology, Saiseikai Maebashi Hospital, Kamishinden-machi 564-1, Maebashi, Gunma, 371-0821, Japan

    Hiroaki Shimizu, Hiroko Koya, Akinori Yuzuriha, Nahoko Hatsumi, Satoru Takada & Toru Sakura

  2. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Takayuki Saitoh, Takumi Hoshino & Yoshihisa Nojima

  3. Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Tomohito Nagaki

Authors
  1. Hiroaki Shimizu
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  2. Takayuki Saitoh
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  3. Hiroko Koya
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  4. Akinori Yuzuriha
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  5. Takumi Hoshino
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  7. Satoru Takada
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  8. Tomohito Nagaki
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  9. Yoshihisa Nojima
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  10. Toru Sakura
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Correspondence to Hiroaki Shimizu.

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Shimizu, H., Saitoh, T., Koya, H. et al. Discrepancy in EBV-DNA load between peripheral blood and cerebrospinal fluid in a patient with isolated CNS post-transplant lymphoproliferative disorder. Int J Hematol 94, 495–498 (2011). https://doi.org/10.1007/s12185-011-0951-3

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  • DOI: https://doi.org/10.1007/s12185-011-0951-3

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