Donor Lymphocyte Transfusion for Epstein-Barr Virus-Associated Lymphoproliferative Disorder Following Unrelated Allogeneic Bone Marrow Transplantation in a Patient with Hypoplastic MDS

Abstract

A 15-year-old girl with hypoplastic myelodysplastic syndrome, who had been treated twice with antithymocyte globulin (ATG), underwent unrelated allogeneic bone marrow transplantation. The preparative regimens consisted of ATG (2.5mg/kg/day×4 days), cyclophosphamide (50mg/kg/day×4 days) and total lymphoid irradiation (4Gy/day×2 days). Showing no signs of acute GVHD, the patient, developed significant nasal obstruction and cervical lymph node swelling on day 58. This was diagnosed as Epstein-Barr virus associated lymphoproliferative disorder (EBV-LPD). She underwent donor leukocyte transfusion (DLT) on day 64, with an infused T cell count of 1.39×10⁶ cells/kg. The LPD disappeared 20 days after DLT; however, she developed GVHD on the skin and liver and subsequently died of uncontrollable gut GVHD on day 160. Caution must be exercised that repeated usage of ATG could be a risk factor of EBV-LPD after bone marrow transplantation and that DLT may result in fatal GVHD.