Postallogeneic stem cell transplant Hodgkin lymphoma: Rare presentation of an uncommon occurrence

Post‐transplant lymphoproliferative disorder (PTLD) is rarely reported in matched sibling donor (MSD) transplants of aplastic anemia (AA), and occurrence of Hodgkin lymphoma in this subgroup is extremely uncommon. Our patient, a 7‐year‐old girl, underwent MSD transplant for AA and developed EBV‐driven Hodgkin lymphoma after tapering of immunosuppression. Post‐transplant lymphoproliferative disorders (PTLDs) represent heterogenous groups of clonal disorders occurring after solid organ and hematopoietic stem cell transplantation. Most of PTLDs are EBV driven and have a frequency of 3.2% in stem cell transplant recipients and 1.1% in matched sibling donor (MSD) transplants.1 Risk factors of PTLD include unrelated donor and haploidentical transplants, use of T‐cell depleting conditioning and higher recipient age. The underlying mechanism is failure of newly instituted donor immune system to control EBV‐infected host cells due to profound T‐cell immune suppression. Epstein‐Barr Virus (EBV) DNA monitoring is done in these high‐risk patients to detect reactivation of EBV and institution of pre‐emptive measures like reduction of immunosuppression and treatment with rituximab. There are only few case reports of PTLD in patients of AA undergoing MSD transplant2 but to our knowledge this is first reported case of EBV‐driven Hodgkin lymphoma occurring after tapering of immunosuppression in patient undergoing MSD HSCT for AA.