LYMPHOCYTOSIS OF DONOR ORIGIN IN CEREBROSPINAL-FLUID, AND MARROW APLASIA AFTER DONOR LEUKOCYTE INFUSION FOR EBV-LYMPHOPROLIFERATIVE DISEASE

A 29-year-old woman underwent a T cell-depleted unrelated donor transp lant for CML in chronic phase, Sixty-three days after marrow infusion, the patient developed fevers and generalized lymphadenopathy, Lymph n ode biopsy was consistent with monoclonal EBV-associated immunoblastic lymphoma for which the patient received 10(5) CD3-positive donor leuk ocytes per kilogram, Six days after leukocyte infusion the patient dev eloped mental status changes without focal neurological deficit, MRI r evealed no mass lesions, Cerebral spinal fluid revealed a white blood cell count of 1650 cells/mm(3) which were shown to be T lymphocytes of donor origin, The CSF was tested and found to be PCR positive for EBV virus interval repeat 1 sequence (IR1), The lymphocytosis and mental status changes resolved without specific intervention, Subsequently sh e developed marrow aplasia, which was believed to be secondary to the infusion of donor leukocytes. Possible mechanisms for these two previo usly unreported side-effects of donor leukocyte infusion are discussed .