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Adverse Occurrence type:
Time to detection:
One year following unrelated allogeneic bone marrow transplantation.
Alerting signals, symptoms, evidence of occurrence:
The patient had a clonal T cell lymphoroliferative process (chronic active EBV infection) and was treated with chemotherapy followed by allogeneic bone marrow transplant. EBV was undetectable but became elevated by EBV screen 1 year after transplant along with a rise in donor-origin CD8 T cells.
Demonstration of imputability or root cause:
Donor origin of post-BMT EBV-positive T cells by XY karyotype (male -> female). Sequencing of EBV lmp1 showed that the virus of post-transplant disease was different from that of pre-transplant disease. Donor virus was not tested and therefore it could not be concluded that this was donor derived.
Recurrence of Chronic Active Epstein-Barr Virus Infection from Donor Cells after Achieving Complete Response Through Allogeneic Bone Marrow Transplantation. Ayako Arai et al. Intern Med. 2012;51(7):777-82.
Expert comments for publication:
This report demonstrates that a clonal T/NK condition known as chronic active EBV infection can recur following successful therapy and bone marrow transplantation. The recurrence in this case involved donor-derived T cells and a strain of EBV that differed from the pre transplant infection. It is not known whether this virus derived from the donor and the case cannot be considered to represent an example of donor disease transmission unless it is actually an unintended EBV positive-> negative transplant. However, one lesson is that this disease can recur, even following apparent successful eradication. So assessment of donor EBV status and close posttransplant monitoring with consideration of pre-emptive therapy may be useful in similar patients.