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Post Transplant Lymphoproliferative Disorder

High incidence of PTLD after non-T-cell-depleted allogeneic haematopoietic stem cell transplantation as a consequence of intensive immunosuppressive treatment

Bone Marrow Transplantation volume 32, pages 97–102 (2003)Cite this article

Summary:

The occurrence of post-transplant lymphoproliferative disorder (PTLD) in relation to immunosuppressive treatment was determined in 257 patients treated with non-T-cell-depleted allogeneic stem cell transplantation from an HLA-matched sibling (173 patients) or unrelated donor (84 patients). The conditioning consisted of total body irradiation and cyclophosphamide (myeloablative conditioning, 250 patients), or fludarabine combined with cyclophosphamide or a single 2 Gy dose of TBI (nonmyeloablative conditioning, seven patients). In transplantations from an unrelated donor, the patients also received antithymocyte globulin (ATG). The prophylaxis against graft-versus-host disease (GVHD) consisted of cyclosporine A, methotrexate, and methylprednisolone. The autopsy reports of deceased patients were systematically reviewed, and the autopsy materials of cases suggestive of PTLD were re-examined histologically for Epstein–Barr virus (EBV). Nineteen patients with EBV-positive PTLD were identified, of whom six had been transplanted from a sibling donor and 13 from an unrelated donor. All the patients who developed PTLD had been given ATG either for the treatment of steroid-resistant acute GVHD (all PTLD patients with a sibling donor and one with an unrelated donor), or as part of the conditioning (all patients with an unrelated donor). In conclusion, in transplantations from an HLA-identical donor with a non-T-cell-depleted graft, the risk of PTLD correlated strongly with the intensity of the immunosuppressive treatment.

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Acknowledgements

This study was financially supported by the Finnish Cancer Research Foundation, the HUCH (EVO) Fund, and the Finnish Technology Advancement Fund.

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Authors and Affiliations

  1. Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    E Juvonen, L Volin & T Ruutu

  2. Department of Virology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    S M Aalto & K Hedman

  3. Department of Pathology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    J Tarkkanen

  4. Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland

    P S Mattila

  5. Department of Medical Genetics, Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    S Knuutila

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  1. E Juvonen
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Juvonen, E., Aalto, S., Tarkkanen, J. et al. High incidence of PTLD after non-T-cell-depleted allogeneic haematopoietic stem cell transplantation as a consequence of intensive immunosuppressive treatment. Bone Marrow Transplant 32, 97–102 (2003). https://doi.org/10.1038/sj.bmt.1704089

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  • DOI: https://doi.org/10.1038/sj.bmt.1704089

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