Sustained remission of an extensive monoclonal, Epstein-Barr virus-associated diffuse large B cell lymphoma in a kidney-pancreas transplant recipient.

Background. Epstein-Barr virus associated posttransplant high-grade large cell lymphoma (EBV-PTL) is thought to be uncurable solely by cessation of immunosuppression. We report a case of EBV-PTL resolving rapidly after alleviation of immunosuppression. A strong cytotoxic memory T cell (CTL) reaction against two individual recipient EBV strains appears to be involved. Methods. EBV strain identification in donor lymphocytes, tumor cells of EBV-PTL, and circulating lymphocytes of recipient was performed by latent membrane protein 1 fingerprinting. Results. Stage IIIB EBV-PTL of recipient type was cured through strong autologous CTL reaction consecutive to alleviation of immunosuppression. Latent membrane protein 1 fingerprinting identified three different EBV strains; namely in lymphoma and peripheral lymphocytes of donor and recipient. Conclusion. In the setting of solid organ transplantation, rigorous reduction of immunosuppression may lead to cure of high grade EBV-PTL, if the recipient delivers a strong host CTL reaction against the epitopes of EBV latency gene products. Infection with two individual EBV strains earlier in life may increase the number of specific CTL clones and increase the memory capacity.