Epstein-Barr virus positive large B-cell lymphoma arising in a patient previously treated with Cladribine for hairy cell leukemia Journal Article

  

Authors:	Bhargava, R.; Barbashina, V.; Filippa, D. A.; Teruya-Feldstein, J.
Article Title:	Epstein-Barr virus positive large B-cell lymphoma arising in a patient previously treated with Cladribine for hairy cell leukemia
Abstract:	We describe the case of a patient treated with 2-chloro-2′-deoxyadenosine, CdA or Cladribine for hairy cell leukemia who subsequently developed an Epstein-Barr virus (EBV)-positive polymorphous large B-cell lymphoma (p-LBCL). The time interval between Cladribine therapy and development of p-BCL was 11 months and morphologically resembled an EBV-positive post transplant lymphoproliferative disorder (PTLD). Molecular genetic studies for EBV-clonality by Southern blot hybridization showed a clonal population of infected cells, implying that this was an EBV induced lesion. The chronology of events suggest that Cladribine, a purine analog which has been previously described to induce long-lasting immunodeficiency, can, in some cases, weaken the host defense mechanism to a level at which an innocuous EBV infection may transform the normal lymphoid cells into an aggressive neoplasm. Unlike most methotrexate-related lymphoproliferative disorders (LPDs), which undergo spontaneous remission after discontinuation of therapy, LPDs secondary to purine analogs often fails to resolve after discontinuation of therapy and requires additional therapy. Our patient was treated with rituximab following the diagnosis of p-LBCL, with the goal of improving the pancytopenia to permit chemotherapy. However, the patient failed to show any dramatic improvements in counts, developed systemic symptoms and progressive ascites. He expired 3 weeks after a second dose of rituximab. Cladribine is a potent immunosuppressive agent and should be included with the list of immunosuppressive agents that may be associated with EBV-related B-cell lymphoproliferative disorders. © 2004 Taylor & Francis Ltd.
Keywords:	immunohistochemistry; human tissue; aged; histopathology; case report; methotrexate; rituximab; molecular genetics; in situ hybridization; b cell lymphoma; gene rearrangement; bone marrow biopsy; lymphoproliferative disease; large cell lymphoma; neoplasms, second primary; cancer classification; fatal outcome; granulocyte colony stimulating factor; cytopenia; recombinant erythropoietin; lymph node biopsy; immunosuppressive agents; epstein barr virus; herpesvirus 4, human; blood smear; cladribine; immunosuppression; hairy cell leukemia; southern blotting; epstein-barr virus; leukemia, hairy cell; lymphoma, large-cell; large b-cell lymphoma; humans; human; male; priority journal; article
Journal Title:	Leukemia and Lymphoma
Volume:	45
Issue:	5
ISSN:	1042-8194
Publisher:	Taylor & Francis Group
Date Published:	2004-05-01
Start Page:	1043
End Page:	1048
Language:	English
DOI:	10.1080/10428190310001625890
PROVIDER:	scopus
PUBMED:	15291365
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-1842555104&partnerID=40&md5=26b333e07b7a62f632d74d5e4c3e2a3e
Notes:	Leuk. Lymphoma -- Cited By (since 1996):7 -- Export Date: 16 June 2014 -- CODEN: LELYE -- Source: Scopus

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