TONSIL LYMPHOMA PRESENTING AS TONSILLITIS AFTER BONE-MARROW TRANSPLANTATION

Bone marrow transplantation for the treatment of leukemia is increasin gly successful in rendering patients disease free. However, it has bec ome evident that the associated severe immunosuppression predisposes t his population to an increased risk for other neoplastic disorders. We report on six patients in whom non-Hodgkin's lymphoma of the tonsilla r region developed within 5 months after T-cell-depleted bone marrow t ransplantation for the treatment of leukemia at Memorial Sloan-Ketteri ng Cancer Center from October 1990 to October 1992. These patients ini tially had what appeared to be infectious exudative pharyngitis/tonsil litis; however, they did not improve with medical therapy. Because of the persistence of pharyngitis/tonsillitis in association with cervica l lymphadenopathy and odynophagia, the patients underwent definitive b iopsy in the form of tonsillectomy, cervical lymph node biopsy, or bot h. Histopathologic review revealed non-Hodgkin's lymphoma. An associat ion with Epstein-Barr virus has been noted in five of these patients. This article is aimed at alerting the clinician to consider the diagno sis of lymphoma in a patient with persistent pharyngitis/tonsillitis d espite adequate medical therapy after bone marrow transplantation.