[Epstein-Barr virus-associated pneumonia in patients with post-transplant lymphoproliferative disease after hematopoietic stem cell transplantation].

OBJECTIVE

To investigate the clinical features of Epstein-Barr virus (EBV) reactivation or infection-induced post-transplant lymphoproliferative disease (PTLD) and EBV-associated pneumonia after hematopoietic stem cell transplantation (HSCT).

METHODS

The clinical data of 7 patients with PTLD, 6 from the 239 patients undergoing allo-HSCT and 1 from the 84 patients undergoing auto-HSCT, were analyzed.

RESULTS

All the 7 patients had extravisceral lymph node enlargement as the primary presentation. Five cases were diagnosed as with diffuse large B-cell lymphoma, 1 case as with polymorphic B-cell hyperplasia, and 1 case peripheral T-cell lymphoma-unspecified. Sex chromosome analysis showed that the tumor cells originated from the donors. ELISA showed that plasma EBV DNA was positive in 6 of the 7 patients and was negative in 1 patient. Chest CT revealed multifocal patches and diffuse ground-glass attenuation in both lungs. EBV-DNA was positive in the bronchoalveolar lavage (BAL) fluid. The T cells in all of the BAL fluid were mainly CD3+ T cells without CD19+ and CD20+ B cells. Lung biopsy showed interstitial and intra-alveolar infiltration, constituted mainly by CD3+ T cells and partly by CD68+ macrophages, however, without CD19+ and CD20+ B cells. The 3 patients with PTLD accompanied by EBV associated-pneumonia had hyperpyrexia and dyspnea, and their condition aggravated rapidly and eventually all the 3 patients died of respiratory failure, of which 1 case with multiple organ failure died within 2 weeks since the onset of PTLD.

CONCLUSIONS

EBV-associated PTLD accompanied by EBV-associated pneumonia is not rare and is always severe. Cytology of BAL fluid and lung biopsy help diagnose.