Fatal lymphoma in association with OKT3 antibody therapy diagnosed by allograft biopsy

We report two renal transplant recipients who died of rapidly fatal lymphoma within 3 months of transplantation. Both presented with fever and deteriorating graft function during the 2nd week of OKT3 therapy for rejection and the removed allograft showed lymphomatous infiltrates. OKT3 may have enhanced in vivo EBV infection in these patients predisposing to lymphomatous transformation. Retrospective review of renal transplants done since July 1986 showed that the incidence of lymphoma in patients receiving OKT3 was 4% and lymphoma has not been seen in patients who did not receive OKT3. Clearly, the risks of OKT3 therapy must be carefully weighed in the aggressively immunosuppressed patient.