Treatment of severe Epstein-Barr virus-induced polyclonal B-lymphocyte proliferation by anti-B-cell monoclonal antibodies. Two cases after HLA-mismatched bone marrow transplantation

Ann Intern Med. 1988 Feb;108(2):199-203. doi: 10.7326/0003-4819-108-2-199.

Abstract

We treated two children who developed Epstein-Barr virus-induced polyclonal B-cell proliferation after HLA-mismatched bone marrow transplantation for congenital immunodeficiency with two monoclonal anti-B-cell antibodies. Lymphoproliferative syndrome occurred between 50 and 60 days after bone marrow infusion, and was diagnosed by the presence of spontaneously growing B cells containing Epstein-Barr-nuclear antigen in the blood and bone marrow. The mouse monoclonal anti-B-cell antibodies used were a CD21-specific antibody recognizing the CR2 receptor on B cells (BL13, IgG1) and a CD24-specific antibody binding B cells at all steps of differentiation (ALB9 IgG1). Both antibodies were given intravenously (0.2 mg/kg/body weight.d for 10 days). All clinical and biological manifestations resolved within 3 weeks of treatment. Recurrence was not seen at 18- and 15-month follow-ups. T-cell function developed normally; B-cell function remained partially deficient in one patient 21 months after bone marrow transplantation. These results suggest that monoclonal anti-B-cell antibodies could be useful in controlling severe polyclonal lymphoproliferative syndrome in profoundly immunodeficient patients after bone marrow transplantation.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antigens, Viral / analysis
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology*
  • Bone Marrow Transplantation*
  • Capsid Proteins*
  • Cell Division
  • Child, Preschool
  • Female
  • HLA Antigens / analysis*
  • Herpesvirus 4, Human / immunology*
  • Histocompatibility Testing
  • Humans
  • Infant
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / microbiology
  • Lymphoproliferative Disorders / therapy*
  • Male
  • Receptors, Antigen, B-Cell / analysis
  • Transplantation, Homologous / adverse effects

Substances

  • Antibodies, Monoclonal
  • Antigens, Viral
  • Capsid Proteins
  • Epstein-Barr viral capsid antigen
  • Epstein-Barr virus early antigen
  • HLA Antigens
  • Receptors, Antigen, B-Cell