Zutter M M, Durnam D M, Hackman R C, Loughran T P, Kidd P G, Ashley R L, Petersdorf E W, Martin P J, Thomas E D
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Am J Clin Pathol. 1990 Dec;94(6):714-21. doi: 10.1093/ajcp/94.6.714.
Secondary lymphoproliferative syndromes in immunosuppressed patients have been characterized as polyclonal or monoclonal B-lineage disorders nearly always associated with Epstein-Barr virus (EBV) infection. The authors now report three patients with a distinctly different lymphoproliferative syndrome. Two patients with common acute lymphoblastic leukemia antigen (CALLA) (CD10)-positive acute lymphoblastic leukemia and one patient with acute myelogenous leukemia, respectively, received high-dose chemoradiotherapy followed by marrow transplantation from either an HLA-identical sibling or HLA-mismatched parent. All three patients developed severe graft-versus-host disease (GVHD), requiring immunosuppressive treatment with corticosteroids. A secondary malignant T-cell lymphoproliferation occurred 2, 21, and 43 months, respectively, after marrow transplantation. In all three cases the lymphoid cells expressed T-cell surface antigens and were morphologically and immunophenotypically distinct from the malignant cells present before transplantation. One tumor was of host cell origin, one was probably of donor origin, and the tumor origin in the third case could not be determined. The authors were unable to find any evidence for EBV, human T-cell lymphotropic virus type I or II, human immunodeficiency virus, or human herpesvirus 6.
免疫抑制患者的继发性淋巴细胞增殖综合征被描述为几乎总是与爱泼斯坦-巴尔病毒（EBV）感染相关的多克隆或单克隆B淋巴细胞系疾病。作者现报告3例具有明显不同淋巴细胞增殖综合征的患者。2例分别患有普通急性淋巴细胞白血病抗原（CALLA）（CD10）阳性急性淋巴细胞白血病的患者和1例急性髓性白血病患者接受了大剂量放化疗，随后接受了来自 HLA 相合同胞或 HLA 不相合父母的骨髓移植。所有3例患者均发生了严重的移植物抗宿主病（GVHD），需要使用皮质类固醇进行免疫抑制治疗。骨髓移植后分别于2个月、21个月和43个月发生了继发性恶性T细胞淋巴细胞增殖。在所有3例病例中，淋巴细胞均表达T细胞表面抗原，在形态学和免疫表型上与移植前存在的恶性细胞不同。1例肿瘤为宿主细胞来源，1例可能为供体来源，第3例病例的肿瘤来源无法确定。作者未发现任何爱泼斯坦-巴尔病毒、I型或II型人类嗜T细胞病毒、人类免疫缺陷病毒或人类疱疹病毒6的证据。
