Progressive bicytopenia due to persistent parvovirus B19 infection after immunochemotherapy with fludarabine/cyclophosphamide and rituximab for relapsed B cell lymphoma

Dept. of Medical Oncology/Hematology/Immunology/Rheumatology/Pulmology, Medical Center II, Eberhard-Karls-University, Tuebingen, Germany. joerg.hartmann@med.uni-tuebingen.de

Human parvovirus B 19 is known as a virus causing erythema infectiosum, arthropathy, transient aplastic crisis and intrauterine fetal death. Healthy hosts are able to clear the virus within weeks after infection. There are a few reports available in the literature regarding immunocompromised renal transplant recipients with persistent infection without seroconversion. Herein, we describe a 56-year old woman with a relapse of grade II follicular lymphoma who received a combined immunochemotherapy of rituximab, fludarabine and cyclophosphamide and subsequently developed a persistent parvovirus B19 infection. In the absence of serum immunoglobulin antibodies, PCR analysis of peripheral blood and bone marrow aspirate were positive for parvovirus B19. Treatment with IVIG treatment resulted in normalization of peripheral blood counts within 7 weeks.