EPSTEIN-BARR VIRUS (EBV) INDUCED POLYCLONAL AND MONOCLONAL B-CELL LYMPHOPROLIFERATIVE DISEASES OCCURRING AFTER RENAL-TRANSPLANTATION - CLINICAL, PATHOLOGIC, AND VIROLOGIC FINDINGS AND IMPLICATIONS FOR THERAPY
EPSTEIN-BARR VIRUS (EBV) INDUCED POLYCLONAL AND MONOCLONAL B-CELL LYMPHOPROLIFERATIVE DISEASES OCCURRING AFTER RENAL-TRANSPLANTATION - CLINICAL, PATHOLOGIC, AND VIROLOGIC FINDINGS AND IMPLICATIONS FOR THERAPY
复制标题
DOI：
10.1097/00000658-198309000-00012
复制
发表时间：
1983-01-01
影响因子：
9
通讯作者：
NAJARIAN, JS
中科院分区：
文献类型：
--
作者：
HANTO, DW;GAJLPECZALSKA, KJ;NAJARIAN, JS
19例肾移植受者出现b淋巴细胞增生性疾病。临床分为两组：a)年轻患者（平均年龄23岁），在移植或抗排斥治疗后不久（平均9个月）出现发热、咽炎和类似传染性单核细胞增多症的淋巴结病；b)老年患者（平均年龄48岁），移植后较晚（平均6年）出现局部肿瘤肿块。组织学上分为多形性弥漫性b细胞增生（PDBH）和多形性b细胞淋巴瘤（PBL）。免疫细胞分型显示多克隆或单克隆b细胞增生。两例患者多克隆增生的恶性转化是由克隆细胞遗传学异常的发现提出的。Epstein-Barr病毒（EBV）特异性血清学、活检标本的Epstein-Barr核抗原染色和EBV DNA分子杂交研究表明EBV是PDBH和PBL的病因。阿昔洛韦是一种体外阻断EBV复制的抗病毒药物，可抑制EBV的口咽脱落，并在4例多克隆b细胞增殖患者中引起完全缓解。单克隆肿瘤对阿昔洛韦耐药。我们建议手术治疗、放疗或化疗可能是对阿昔洛韦耐药肿瘤患者更合适的治疗方法。治疗决策不仅需要记录这些肿瘤的病毒病因，还需要免疫和细胞遗传学分析，以确定个体患者的肿瘤演变阶段。
Nineteen renal allograft recipients developed B-cell lymphoproliferative diseases. Clinically there were two groups: a) young patients (mean age, 23 years) who presented soon (mean, 9 months) after transplantation or antirejection therapy with fever, pharyngitis, and lymphadenopathy resembling infectious mononucleosis, and b) older patients (mean age, 48 years) who presented later (mean, 6 years) after transplantation with localized tumor masses. Histologically, the diseases were classified as polymorphic diffuse B-cell hyperplasia (PDBH) or polymorphic B-cell lymphoma (PBL). Immunologic cell typing revealed either polyclonal or monoclonal B-cell proliferations. Malignant transformation of polyclonal proliferations in two patients was suggested by the finding of clonal cytogenetic abnormalities. Epstein-Barr virus (EBV) specific serology, staining of biopsy specimens for the Epstein-Barr nuclear antigen, and EBV DNA molecular hybridization studies implicated EBV as the cause of both PDBH and PBL. Acyclovir, an antiviral agent that blocks EBV replication in vitro, inhibited oropharyngeal shedding of EBV and caused complete remission in four patients with polyclonal B-cell proliferations. The monoclonal tumors were acyclovir resistant. We suggest that surgical treatment, radiotherapy, or chemotherapy may be more appropriate therapy in selected patients with acyclovir resistant tumors. Therapeutic decisions require not only documentation of the viral etiology of these tumors, but also immunologic and cytogenetic analysis to determine the stage of tumor evolution in individual patients.