ANTI-B CELL ANTIBODIES FOR THE TREATMENT OF MONOCLONAL EPSTEIN-BARR VIRUS-INDUCED LYMPHOPROLIFERATIVE SYNDROME AFTER MULTIVISCERAL TRANSPLANTATION

Epstein-Barr virus-induced lymphoproliferative syndrome (EBV-LPS) is a ssociated with OKT3 therapy in transplant patients. Response to chemot herapy or radiation is generally poor, while polyclonal EBV-LPS has ha d favorable responses to therapy with CD21 and CD24 monoclonal antibod ies. Oligoclonal disease has not been previously reported to respond t o therapy with CD21 and CD24. We report a 27-y old woman who developed a monoclonal EBV-LPS (confirmed by southern analysis of tumour for EB V DNA) after 180 mg of OKT3 for a multivisceral transplant. The patien t achieved clinical remission for more than 2 months, but later died f rom cytomegalovirus pneumonia. Levels of CD21 and CD24 were >2000 ng/m l during therapy and no human anti-mouse antibodies were formed. perip heral blood B cells were cleared during therapy. We conclude that CD21 and CD24 monoclonal antibodies may be of value in the therapy of olig oclonal EBV-LPS, and merit further study.