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Shahid S, Rossi C, Vyas P, Bollard C, Dave H. Iatrogenic immunodeficiency-associated lymphoproliferative disorder in a child with B-cell acute lymphoblastic leukemia. Pediatr Hematol Oncol 2019; 36:309-316. [PMID: 31314679 DOI: 10.1080/08880018.2019.1637982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs) are a group of lymphoid proliferations or lymphomas that are well known to be associated with an immunosuppressed state. These disorders most commonly occur following hematopoietic or solid organ transplantation (called post-transplant lymphoproliferative disorders or PTLD), but cases have also been described during the treatment of autoimmune and rheumatologic disorders by immunosuppressive and immunomodulatory medications. These disorders are strongly associated with infection by the Epstein-Barr virus (EBV) as a result of impaired immune function in the immunosuppressed state. While this phenomenon has been well documented in autoimmune conditions, cases affecting pediatric patients while on anti-leukemia chemotherapy are lacking. In this report, we describe a case of a pediatric immunosuppressed patient with recurrent sinusitis found to have a nasopharyngeal mass consistent with EBV-positive B-cell lymphoproliferative disorder resembling a polymorphic PTLD during the maintenance phase of B-cell Acute Lymphoblastic Leukemia (ALL) therapy. The patient was successfully treated with rituximab without any cytotoxic chemotherapy, highlighting the importance of recognizing this clinical entity in non-transplant patients with hematologic malignancies.
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Affiliation(s)
- Sanam Shahid
- Children's National Health System , Washington , D.C
| | | | - Pranav Vyas
- Children's National Health System , Washington , D.C
| | | | - Hema Dave
- Children's National Health System , Washington , D.C
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Lu BY, Kojima L, Huang MS, Friedmann AM, Ferry JA, Weinstein HJ. Facial manifestations of Epstein-Barr virus-related lymphoproliferative disease in childhood acute lymphoblastic leukemia in remission: Two atypical presentations. Pediatr Blood Cancer 2016; 63:2042-5. [PMID: 27392033 DOI: 10.1002/pbc.26102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/01/2016] [Accepted: 05/22/2016] [Indexed: 11/09/2022]
Abstract
Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) rarely occurs in patients with acute lymphoblastic leukemia (ALL), who have not received hematopoietic transplantation. We describe EBV-LPD manifesting as facial lesions in two children with ALL in remission. One patient was a 16-year-old male with T-cell ALL with an EBV-positive angiocentric polymorphous lip lesion presenting as right-sided facial swelling. The other patient was a 12-year-old male with B-cell ALL with an EBV-positive polymorphous lymphoplasmacytic infiltrate presenting as bilateral dacryoadenitis. Neither patient had known primary immunodeficiencies. Both cases improved with immunosuppressant de-escalation. These cases suggest that immunosuppression induced by maintenance chemotherapy is sufficient to promote EBV-LPD.
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Affiliation(s)
- Benjamin Y Lu
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Lisa Kojima
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mary S Huang
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Alison M Friedmann
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howard J Weinstein
- Division of Pediatric Hematology & Oncology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts.
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Nakashima K, Kodama Y, Nishikawa T, Nishimura M, Ito N, Fukano R, Nomura Y, Ueba T, Inoue T, Oshima K, Okamura J, Inagaki J. Central nervous system EBV lymphoproliferative disorder in a patient with rhabdomyosarcoma. Pediatr Int 2016; 58:388-390. [PMID: 26738608 DOI: 10.1111/ped.12812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
Epstein-Barr virus associated lymphoproliferative disorder (EBV-LPD) occurs in patients with immunodeficiency, but it has not been well described in patients who have received chemotherapy for solid tumors. We describe a child with rhabdomyosarcoma who developed isolated central nervous system (CNS) EBV-LPD during combination chemotherapy with vincristine, actinomycin D and cyclophosphamide. The patient was treated with high-dose methotrexate (HD-MTX) for CNS EBV-LPD and then treated with rituximab in addition to HD-MTX because of the emergence of LPD in the liver. I.v. rituximab combined with HD-MTX might be effective therapy for CNS EBV-LPD.
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Affiliation(s)
- Kentaro Nakashima
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichi Kodama
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Takuro Nishikawa
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Miho Nishimura
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Nobuhiro Ito
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Reiji Fukano
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuko Nomura
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Department of Neurosurgery, Kochi Medical School, Kochi, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Koichi Oshima
- Department of Pathology, School of Medicine, Kurume University, Fukuoka, Japan
| | - Jun Okamura
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Jiro Inagaki
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
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Atabay B, Türker M, Oztürk C, Sütçüoğlu S, Oniz H, Ozer EA. Central nervous system involvement of epstein barr virus associated lymphoproliferative disorder in a child with acute lymphoblastic leukemia: successful treatment with rituximab and interferon-alpha. Turk J Haematol 2014; 30:58-62. [PMID: 24385755 PMCID: PMC3781665 DOI: 10.4274/tjh.2011.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/21/2012] [Indexed: 12/01/2022] Open
Abstract
Central nervous system (CNS) involvement of Epstein-Barr virus (EBV)-associated lymphoproliferative disease is a rare and serious complication in children with leukemia. Although rituximab therapy seems to be promising in these cases, persistent hypogammaglobulinemia may appear after treatment due to complete depletion of normal B lymphocytes in the peripheral blood. Here we report isolated CNS involvement of EBV-associated lymphoproliferative disorder in a 4-year-old boy with acute leukemia. The patient was treated with rituximab and interferon alpha; however, persistent hypogammaglobulinemia developed as a complication. Given the rarity of the complication in children receiving these agents, our experience with such a case may be helpful to others. Conflict of interest:None declared.
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Affiliation(s)
- Berna Atabay
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Meral Türker
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Can Oztürk
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Sümer Sütçüoğlu
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Haldun Oniz
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
| | - Esra Arun Ozer
- Tepecik Training and Research Hospital, Department of Pediatrics Clinic, İzmir, Turkey
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Szczepański T, de Vaan GAM, Beishuizen A, Bogman J, Jansen MWJC, van Wering ER, van Dongen JJM. Acute lymphoblastic leukemia followed by a clonally-unrelated EBV-positive non-Hodgkin lymphoma and a clonally-related myelomonocytic leukemia cutis. Pediatr Blood Cancer 2004; 42:343-9. [PMID: 14966831 DOI: 10.1002/pbc.10466] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Complicating malignant hematopoietic proliferations might severely hamper the course of acute lymphoblastic leukemia (ALL) in patients with an otherwise good prognosis. It is important to distinguish whether such neoplastic proliferations represent ALL relapses or secondary treatment-related malignancies. PROCEDURE We present an 11-year-old girl with precursor-B-ALL in whom maintenance treatment was complicated by an isolated ALL relapse in the brain, nodular lymphoproliferations in the liver, and an isolated myelo-monocytic leukemia cutis. All these hemato-oncologic malignancies occurred in the background of a secondary immunodeficiency, most likely caused by cytotoxic treatment. RESULTS AND CONCLUSIONS Using a stepwise molecular approach, we were able to demonstrate that the liver infiltrates were Epstein-Barr virus (EBV)-positive, contained monoclonal mature B-cells with immunoglobulin heavy chain gene (IGH) gene rearrangements unrelated to the primary ALL, and thus represented a true secondary non-Hodgkin lymphoma (NHL). In contrast, the skin infiltrates consisted of myelo-monocytic cells with clonal IGH and T-cell receptor gamma gene rearrangements, identical to the precursor-B-ALL blasts at diagnosis. Thus, the disease course of the precursor-B-ALL patient was complicated by two different isolated extramedullary relapses (brain and skin) and a secondary EBV(+) B-NHL.
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MESH Headings
- Child
- Clone Cells/pathology
- DNA, Viral/analysis
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Herpesvirus 4, Human/genetics
- Humans
- Leukemia/etiology
- Leukemia/pathology
- Leukemia, Myelomonocytic, Acute/etiology
- Leukemia, Myelomonocytic, Acute/pathology
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/pathology
- Neoplasms, Multiple Primary/etiology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
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Affiliation(s)
- Tomasz Szczepański
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Heath JA, Broxson EH, Dole MG, Filippa DA, George D, Lyden D, Dunkel IJ. Epstein-Barr virus-associated lymphoma in a child undergoing an autologous stem cell rescue. J Pediatr Hematol Oncol 2002; 24:160-3. [PMID: 11998794 DOI: 10.1097/00043426-200202000-00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD) is a serious disorder seen in various states of immunodeficiency, often with a fatal outcome. In this article, a patient with EBV-lymphoma after autologous stem cell rescue for treatment of a nonhematologic solid tumor is described. The child, a 4-year-old boy, had unilateral retinoblastoma with metastatic spread to the central nervous system. He had previously received both local tumor bed and craniospinal radiation therapy together with intensive myeloablative alkylator chemotherapy before autologous stem cell rescue. Histologically confirmed lymphoma with evidence of active EBV proliferation developed within cervical lymph nodes 3 weeks after his first autologous stem cell rescue. A complete clinical remission of the lymphadenopathy was obtained after infusions of rituximab (an anti-CD20 monoclonal antibody), acyclovir, and high-titer anticytomegalovirus immunoglobulin. The patient died approximately 6 months later of persistent and progressive retinoblastoma without any clinical evidence of lymphoma. It is concluded that EBV-LPD should be included in the differential diagnosis in patients in whom lymphadenopathy develops after autologous stem cell rescue.
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MESH Headings
- Acyclovir/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Carboplatin/administration & dosage
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/radiotherapy
- Central Nervous System Neoplasms/secondary
- Child, Preschool
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Disease Progression
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/drug therapy
- Etoposide/administration & dosage
- Eye Enucleation
- Eye Neoplasms/drug therapy
- Eye Neoplasms/pathology
- Eye Neoplasms/radiotherapy
- Eye Neoplasms/surgery
- Fatal Outcome
- Hematopoietic Stem Cell Transplantation
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunocompromised Host
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Immunotherapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Meningeal Neoplasms/drug therapy
- Meningeal Neoplasms/radiotherapy
- Meningeal Neoplasms/secondary
- Meningeal Neoplasms/therapy
- Methylprednisolone/therapeutic use
- Neoplasm Recurrence, Local
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/therapy
- Neoplasms, Second Primary/virology
- Optic Nerve Neoplasms/radiotherapy
- Optic Nerve Neoplasms/secondary
- Radiotherapy, Adjuvant
- Retinoblastoma/drug therapy
- Retinoblastoma/radiotherapy
- Retinoblastoma/secondary
- Retinoblastoma/surgery
- Retinoblastoma/therapy
- Rituximab
- Thiotepa/therapeutic use
- Vincristine/therapeutic use
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Affiliation(s)
- John A Heath
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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