Epstein-Barr Virus–Induced CD30-Positive Diffuse Large B-Cell Lymphoma in a Patient With Mixed-Phenotypic Leukemia Treated With Clofarabine

Abstract

Lymphoproliferative disorders (LPD) have been reported in several clinical settings associated with immunosuppression such as primary immune deficiency, HIV infection, bone marrow or solid organ transplantation, methotrexate or tumor necrosis factor-therapy, and aging.1,2 A significant number of these cases are associated with EBV. While EBV-positive LPD have been documented in patients with low grade lymphoma’s treated with purine analogues including cladribine 3,4 or fludarabine,5,6 we could not identify any reports of EBV-positive LPD after purine analogue (including clofarabine) therapy for AML or MPAL. As clofarabine is being used with increasing frequency in AML therapy 7,8 such phenomenon may be noted with increasing frequency in the future. In our patient R-CHOP (rituximab, cyclophosphamide, his-adriamycin, vincristine, prednisone) therapy 9,10 effectively treated the EBV-positive LPD and this may help guide treatment in future occurrences of a similar nature.