TREATMENT OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN THE CENTRAL-NERVOUS-SYSTEM OF A LUNG-TRANSPLANT RECIPIENT USING ALLOGENEIC LEUKOCYTES

Posttransplant Epstein-Barr virus-related lymphoproliferative disease (PT-LPD) is a common and often fatal complication following solid orga n and hematopoietic stem cell transplantation. PT-LPD following solid organ transplantation generally occurs in B cells of recipient origin in contrast to PT-LPD in marrow transplant recipients, which is exclus ively of donor origin. The efficacy of adoptive immunotherapy using do nor leukocytes to treat PT-LPD in bone marrow transplant recipients ha s recently been reported. Because PT-LPD in solid organ transplant rec ipients is generally of recipient origin, the potential application of adoptive immunotherapy of PT-LPD in solid organ recipients obligates the use of either autologous or allogeneic HLA identical leukocytes, w ith the attendant risk of organ rejection if cells mismatched with the transplanted organ are used. Nonirradiated allogeneic mononuclear cel ls from an Epstein-Barr virus (EBV)-seropositive, HLA-identical normal sibling were used to treat a monoclonal EBV lymphoma of recipient ori gin in the central nervous system of a child who had undergone an HLA- mismatched cadaveric lung transplant. The patient received three separ ate mononuclear cell infusions over a 9-month period, each containing 1x10(6) CD3(+) mononuclear cells per kilogram. Complete clinical, radi ological, and pathological remission was achieved with this treatent r egimen. The response correlated with in vivo reconstitution of normal EBV-specific cytotoxic activity and cytotoxic T lymphocyte precursor f requency. Use of allogeneic HLA-compatible mononuclear cells may thus offer an additional mode of therapy for EBV-related lymphoproliferativ e disease in selected solid organ transplant recipients refractory to conventional therapies.