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Clonal gammopathies and allogeneic stem cell transplantation

Bone Marrow Transplantation volume 41, page 317 (2008)Cite this article

We read with interest, the paper from Lim et al.1 recently published in your journal. In the paper, the authors claimed that there was an increase of clonal gammopathies following alemtuzumab-based reduced-intensity conditioning hematopoietic stem cell transplantation. The authors conclude that there was no difference in the number of viral infections (that is, CMV and HBV) in patients developing clonal gammopathies. The major causative role for the development of clonal gammopathies after organ transplantation is thought to be EBV as supported by several reports in the literature.2, 3, 4 The M component in this setting2 is predominantly IgG followed by IgM and this completely overlaps the results showed by Lim et al.1 Furthermore, the appearance of clonal gammopathy, although related to EBV reactivation, documented either by EBV viremia or EBER1 expression on infected lymphocytes was variably associated with the development of posttransplant lymphoproliferative disorder (PTLD).3 Since alemtuzumab included either in reduced-intensity conditioning or immunosuppressive regimens, is associated with a significant increase in EBV reactivation,5, 6 the development of clonal gammopathies should lead to the monitoring of EBV viremia. Given the association among clonal gammopathies, EBV reactivation and the development of PTLD, this occurrence should not always be seen as benign.

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References

  1. Lim ZY, Ingram W, Brand R, Akthari M, Milojkovic D, Ho AY et al. Clonal gammopathies following alemtuzumab-based reduced intensity conditioning haematopoietic stem cell transplantation: association with chronic graft-versus-host disease and improved overall survival. Bone Marrow Transplant 2007; 40: 747–752.

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  1. Haematology Institute, A Gemelli Hospital, Catholic University, Rome, Italy

    F Sorà, L Laurenti, P Chiusolo, S De Matteis, G Leone & S Sica

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  1. F Sorà
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  2. L Laurenti
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  3. P Chiusolo
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  5. G Leone
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  6. S Sica
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Correspondence to F Sorà.

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Sorà, F., Laurenti, L., Chiusolo, P. et al. Clonal gammopathies and allogeneic stem cell transplantation. Bone Marrow Transplant 41, 317 (2008). https://doi.org/10.1038/sj.bmt.1705916

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