Epstein-Barr virus-associated post-transplant lymphoproliferative disease during dasatinib treatment occurred 10 years after umbilical cord blood transplantation. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Yamada, Akiko; Katagiri, Seiichiro; Moriyama, Mitsuru; Asano, Michiyo; Suguro, Tamiko; Yoshizawa, Seiichiro; Akahane, Daigo; Tanaka, Yuko; Furuya, Nahoko; Fujimoto, Hiroaki; Gotoh, Moritaka; Aota, Yasuo; Nakamura, Naoya; Gotoh, Akihiko
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 7(2021)
• Page Start: 1076
• Page End: 1079
• Publication Date: 2021-07
• Subjects: Epstein–Barr virus -- Post-transplant lymphoproliferative disease -- dasatinib; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2021.01.009
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Post-transplant lymphoproliferative disease (PTLD) is defined as a lymphoma that occurs after solid-organ or hematopoietic stem-cell transplantation (HSCT), caused by immunosuppression and Epstein–Barr virus (EBV) reactivation. It is an important post-transplant complication that can be fatal. After HSCT, most PTLD occurs within 2 years. Recent evidence suggests that tyrosine kinase inhibitors (TKIs) are expected to be effective maintenance therapy after HSCT for Philadelphia chromosome-positive leukemia. However, it is unclear whether the use of TKIs might pose a risk of developing PTLD after HSCT. We present the first case of late-onset PTLD during dasatinib treatment, which occurred 10 years after umbilical cord blood transplantation (CBT). A 59-year-old man who received CBT for chronic myeloid leukemia blast phase needed long-term dasatinib therapy for molecular relapse. Ten years after CBT, he developed diffuse-large B-cell lymphoma (DLBCL). We observed chimerism of the DLBCL sample, which indicated complete donor type and EBV-DNA, and the patient was diagnosed with PTLD. Because of treatment resistance, he died 6 months after PTLD onset. Although he received no long-term administration of immunosuppressive agents, he received long-term dasatinib treatment, which suggests that prolonged dasatinib use after CBT caused EBV reactivation and led to PTLD. Our case suggests that the potential contribution of molecular-targeted agents after HSCT to the development of PTLD should be carefully considered.