Unmanipulated donor lymphocytes for EBV-related PTLD after T-cell depleted HLA-haploidentical transplantation

Pediatrics. 2012 Jan;129(1):e189-94. doi: 10.1542/peds.2011-0636. Epub 2011 Dec 5.

Abstract

Epstein-Barr virus (EBV)-related post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication in patients given T-cell-depleted hematopoietic stem cell transplantation from an HLA-haploidentical relative (haplo-HSCT). We report the case of a child who developed severe EBV-related PTLD after haplo-HSCT from his mother. Despite receiving the anti-CD20 monoclonal antibody, the patient presented with intestinal obstruction due to huge abdominal lymphadenopathy, hematemesis, and nodulary pulmonary lesions. Histology showed that the lesions were due to CD20-/CD19+ large neoplastic B cells. The patient underwent double intestinal resection with partial abdominal lymphadenectomy and then received 3 monthly doses of donor-derived unmanipulated mononuclear cells. The initial dose of CD3+ cells was 3 10(5)/kg recipient body weight. The 2 additional doses consisted of 5 10(5) CD3+ cells/kg. No sign or symptom attributable to graft-versus-host disease was observed, and the patient completely cleared EBV-related lesions. The child was disease-free for 13 months after the first lymphocyte infusion. This case demonstrates that repeated infusions of controlled numbers of donor CD3+ cells cure EBV-related PTLD in haplo-HSCT without inducing graft-versus-host disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • CD3 Complex / analysis
  • Child, Preschool
  • Epstein-Barr Virus Infections / complications
  • Epstein-Barr Virus Infections / therapy*
  • HLA Antigens / analysis*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lymphocyte Depletion*
  • Lymphocyte Transfusion*
  • Lymphocytes / immunology
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / therapy*
  • Lymphoproliferative Disorders / virology
  • Male
  • Rituximab
  • T-Lymphocytes
  • Transplantation, Homologous

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • CD3 Complex
  • HLA Antigens
  • Immunosuppressive Agents
  • Rituximab