Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Oct 28, 2024; 16(10): 600-607
Published online Oct 28, 2024. doi: 10.4329/wjr.v16.i10.600
Epstein-Barr virus positive post-transplant lymphoproliferative disorder with significantly decreased T-cell chimerism early after transplantation: A case report
Qing-Na Guo, Hai-Sheng Liu, Lin Li, Dian-Ge Jin, Ji-Min Shi, Xiao-Yu Lai, Li-Zhen Liu, Yan-Min Zhao, Jian Yu, Yan-Yuan Li, Fang-Quan Yu, Zhe Gao, Jiao Yan, He Huang, Yi Luo, Yi-Shan Ye
Qing-Na Guo, Lin Li, Dian-Ge Jin, Ji-Min Shi, Xiao-Yu Lai, Li-Zhen Liu, Yan-Min Zhao, Jian Yu, Jiao Yan, He Huang, Yi Luo, Yi-Shan Ye, Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Qing-Na Guo, Hai-Sheng Liu, Zhe Gao, Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050035, Hebei Province, China
Dian-Ge Jin, Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou 310003, Zhejiang Province, China
Yan-Yuan Li, Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Fang-Quan Yu, Department of Hematology, Jinhua People’s Hospital, Jinhua 321000, Zhejiang Province, China
Co-first authors: Qing-Na Guo and Hai-Sheng Liu.
Co-corresponding authors: Yi Luo and Yi-Shan Ye.
Author contributions: Ye YS, Huang H, Luo Y, and Liu HS designed this study; Guo QN, Li L, Jin DG, Shi JM, Lai XY, Liu LZ, Zhao YM, Yu J, and Li YY performed data collection and analysis; Guo QN, Li L, Yu FQ, Gao Z, and Yan J wrote the first draft of the manuscript. All authors have reviewed and approved the final manuscript. Guo QN and Liu HS contributed equally to this work as co-first authors. This manuscript is a clinical case report. As a case study, there will be multiple fields involved in clinical practice, and guidance and support in different fields are required. Therefore, a multidisciplinary team of professionals is necessary for this study. This research work was conceptualized under the joint leadership of Luo Y and Ye YS. This manuscript was reviewed by Luo Y and Ye YS, who also collaboratively managed the patient in the clinical setting. These authors contributed equally to this work and are therefore designated as co-corresponding authors.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: The authors declare no competing interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Shan Ye, MD, PhD, Doctor, Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 1367 West Wenyi Road, Yuhang District, Hangzhou 310003, Zhejiang Province, China. yeyishan@hotmail.com
Received: May 24, 2024
Revised: August 20, 2024
Accepted: September 19, 2024
Published online: October 28, 2024
Processing time: 156 Days and 23.7 Hours
Abstract
BACKGROUND

Post-transplant lymphoproliferative disorder (PTLD) is a rare but highly fatal complication occurring after allogeneic hematopoietic cell transplantation (allo-HCT) or solid organ transplantation (SOT). Unlike SOT, PTLD after allo-HCT usually originates from the donor and is rarely accompanied by a loss of donor chimerism.

CASE SUMMARY

We report a case of Epstein-Barr virus positive PTLD manifesting as diffuse large B-cell lymphoma (DLBCL) with significantly decreased T-cell chimerism early after allo-HCT. A 30-year-old patient with acute myeloid leukemia underwent unrelated allo-HCT after first complete remission. Nearly 3 mo after transplantation, the patient developed cervical lymph node enlargement and gastric lesions, both of which were pathologically suggestive of DLBCL. Meanwhile, the patient experienced a significant and persistent decrease in T-cell chimerism. A partial remission was achieved after chemotherapy with single agent rituximab and subsequent R-CHOP combined chemotherapy.

CONCLUSION

The loss of T-cell chimerism and the concomitant T-cell insufficiency may be the cause of PTLD in this patient.

Keywords: Post-transplant lymphoproliferative disorder; T-cell chimerism; Epstein-Barr virus; T cell function; Case report

Core Tip: In this paper, we report a case of post-transplant lymphoproliferative disorder (PTLD) after unrelated allogeneic hematopoietic cell transplantation in which the donor T-cell chimerism decreased significantly at the time of PTLD diagnosis, and the primary disease was still in remission. The decreased chimerism in the donor T-cell of this patient may lead to a decreased ability to control Epstein-Barr virus reactivation, which is directly related to the occurrence of PTLD.