Monitoring of EBV-DNA load in patient 4.

A 5-year-old boy with HLH received a TCD bone marrow graft from a mismatched unrelated donor. The early posttransplant course was uncomplicated, without clinical signs of GVHD. Despite the successful engraftment of BMT, repeated infusions of donor T cells, and a booster of peripheral stem cells, recipient T cells persisted in the blood. Lymphopenia and positive PCR tests for CMV-DNA in the blood prompted preemptive antiviral therapy. EBV-CTLs were infused on days +102 and +125, at which time the patient presented with fever and abdominal pain. A bilateral neck mass developed rapidly, and an excisional biopsy performed on day +140 disclosed a highly malignant EBV-positive NHL with dissemination to the abdomen and central nervous system. The patient died of progressive disease 2 weeks after diagnosis.