Posttransplantation Lymphoproliferative DiseaseTreated by Retransplantation

Epstein–Barr virus- (EBV-) induced posttransplantation lymphoproliferative disease (PTLD) is a life-threatening complicationfollowing allogeneic stem cell transplantation. *e main risk factor is anti-thymocyte globulin (ATG). Patients who fail first-linetreatment with rituximab have a poor prognosis. *ough adoptive transfer of EBV-specific Tcells is a potentially effective option,it is not readily available. In this case report, the patient developed PTLD following transplantation for aplastic anemia using ATGas part of the conditioning. He failed rituximab treatment and developed graft failure. We were aware that the stem cell donor hada recent EBV infection prior to transplantation, whereas the patient most likely was EBV negative before transplant. We describeour strategy to meet the patient’s urgent need for EBV-specific Tcells, as well as new hematopoietic stem cells. *e same donor wasused for a second transplant, using peripheral blood stem cells. *e conditioning used was thiotepa/busulfan/fludarabin with asingle dose of cyclophosphamide after transplant as graft-versus-host disease (GVHD) prophylaxis. *e EBV DNA levels fell whenconditioning was started, and have been undetectable since day +15 and remained so till 18 months after transplantation. *epatient is doing well. *is case reports successful use of cyclophosphamide after transplantation as GVHD prophylaxis, preservingvirus-specific immunity.