Monoclonal Epstein-Barr virus-related lymphoproliferative disorder following adult acute lymphoblastic leukaemia

A 31-year-old patient in remission of acute lymphoblastic leukaemia (ALL), receiving oral maintenance chemotherapy (6-mercaptopurine, methotrexate (MT X), cyclophosphamide), developed a monoclonal, Epstein-Barr virus (EBV)-rel ated lymphoproliferative disorder (LPD). Treatment consisted of excisional biopsy and the discontinuation of maintenance chemotherapy. To our knowledg e, this is the first such report in an adult. The histological similarity t o previous reports of lymphomatoid granulomatosis' following paediatric ALL suggests that they are the same disease. MTX may play a central role in th e development of LPD in this setting. Although it is a rare complication of ALL, EBV-related LPD should be considered in patients who develop lymphade nopathy.