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Devine KJ, Seif AE, Reilly AF. Outcomes of children treated for multiple Epstein-Barr virus-associated post-transplant tumors. Pediatr Transplant 2023; 27:e14583. [PMID: 37485777 DOI: 10.1111/petr.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/08/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND After solid organ transplantation, children are at risk for Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and smooth muscle tumors. Little is known about the clinical course, Epstein-Barr viral load variations, and optimal treatment for such patients. We set forth to understand the course of repeated episodes of post-transplant lymphoproliferative disorder and smooth muscle tumors. METHODS We performed a retrospective chart review of patients up to 21 years old with solid organ transplantation and post-transplant lymphoproliferative disorder at the Children's Hospital of Philadelphia from January 2003 through June 30, 2020. RESULTS Six patients had multiple episodes of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and smooth muscle tumors. When the second episode was discovered, only one patient was symptomatic. Histology differed from diagnosis in four patients. Treatment included viral-specific T-lymphocytes (2), rituximab (3), reduction in immunosuppression alone (1). Five patients had complete response, and one had stable disease, but three patients developed a subsequent tumor. Two patients developed Epstein-Barr virus-associated smooth muscle tumors. Of these six patients, four are alive. The deaths were not related to their tumors. CONCLUSIONS Despite a complete response to initial therapy, children are at risk for repeated episodes of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and smooth muscle tumors. Histology and location were not typically consistent with initial diagnosis, suggesting these are second primaries rather than recurrences. Disease may be managed with individualized treatment plans but EBV-specific T cells need further study in such tumors.
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Affiliation(s)
- Kaitlin J Devine
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alix E Seif
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne F Reilly
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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El-Atoum B, Ebert M, Bucher B, Afify Z. Is 18F-FDG PET/CT Effective in Identifying True Residual Disease After Treatment of Pediatric PTLD? J Nucl Med 2021; 63:167-168. [PMID: 33990401 DOI: 10.2967/jnumed.121.262414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Batool El-Atoum
- University of Utah and Primary Children's Hospital Salt Lake City, Utah
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3
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Montes de Jesus F, Dierickx D, Vergote V, Noordzij W, Dierckx RAJO, Deroose CM, Glaudemans AWJM, Gheysens O, Kwee TC. Prognostic superiority of International Prognostic Index over [ 18F]FDG PET/CT volumetric parameters in post-transplant lymphoproliferative disorder. EJNMMI Res 2021; 11:29. [PMID: 33738643 PMCID: PMC7973341 DOI: 10.1186/s13550-021-00769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Post-transplant lymphoproliferative disorders (PTLDs) are a spectrum of hematological malignancies occurring after solid organ and hematopoietic stem cell transplantation. [18F]FDG PET/CT is routinely performed at PTLD diagnosis, allowing for both staging of the disease and quantification of volumetric parameters, such as whole-body metabolic tumor volume (MTV) and total lesion glycolysis (TLG). In this retrospective study, we aimed to determine the prognostic value of MTV and TLG in PTLD patients, together with other variables of interest, such as the International Prognostic Index (IPI), organ transplant type, EBV tumor status, time after transplant, albumin levels and PTLD morphology. Results A total of 88 patients were included. The 1-, 3-, 5- year overall survival rates were 67%, 58% and 43% respectively. Multivariable analysis indicated that a high IPI (HR: 1.56, 95% CI: 1.13–2.16) and an EBV-negative tumor (HR: 2.71, 95% CI: 1.38–5.32) were associated with poor overall survival. Patients with a kidney transplant had a longer overall survival than any other organ recipients (HR: 0.38 95% CI: 0.16–0.89). IPI was found to be the best predicting parameter of overall survival in our cohort. Whole-body MTV, TLG, time after transplant, hypoalbuminemia and PTLD morphology were not associated with overall survival. Conclusion [18F]FDG PET/CT whole-body volumetric quantitative parameters were not predictive of overall survival in PTLD. In our cohort, high IPI and an EBV-negative tumor were found to predictors of worse overall survival while kidney transplant patients had a longer overall survival compared to other organ transplant recipients
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Affiliation(s)
- F Montes de Jesus
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - D Dierickx
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - V Vergote
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - W Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - C M Deroose
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - T C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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4
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Song H, Guja KE, Iagaru A. 18F-FDG PET/CT for Evaluation of Post-Transplant Lymphoproliferative Disorder (PTLD). Semin Nucl Med 2021; 51:392-403. [PMID: 33455722 DOI: 10.1053/j.semnuclmed.2020.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Post-transplant lymphoproliferative disorders (PTLD) are a spectrum of heterogeneous lymphoproliferative conditions that are serious and possibly fatal complications after solid organ or allogenic hematopoietic stem cell transplantation. Most PTLD are attributed to Epstein-Barr virus reactivation in B-cells in the setting of immunosuppression after transplantation. Early diagnosis, accurate staging, and timely treatment are of vital importance to reduce morbidity and mortality. Given the often nonspecific clinical presentation and disease heterogeneity of PTLD, tissue biopsy and histopathological analysis are essential to establish diagnosis and most importantly, determine the subtype of PTLD, which guides treatment options. Advanced imaging modalities such as 18F-FDG PET/CT have played an increasingly important role and have shown high sensitivity and specificity in detection, staging, and assessing treatment response in multiple clinical studies over the last two decades. However, larger multicenter prospective validation is still needed to further establish the clinical utility of PET imaging in the management of PTLD. Significantly, new hybrid imaging modalities such as PET/MR may help reduce radiation exposure, which is especially important in pediatric transplant patients.
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Affiliation(s)
- Hong Song
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Dr, H2200, Stanford, 94305, USA
| | - Kip E Guja
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Dr, H2200, Stanford, 94305, USA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Dr, H2200, Stanford, 94305, USA.
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Burns DM, Clesham K, Hodgson YA, Fredrick L, Haughton J, Lannon M, Hussein H, Shin JS, Hollows RJ, Robinson L, Byrne C, McNamara C, Vydianath B, Lennard AL, Fields P, Johnson R, Wright J, Fox CP, Cwynarski K, Chaganti S. Real-world Outcomes With Rituximab-based Therapy for Posttransplant Lymphoproliferative Disease Arising After Solid Organ Transplant. Transplantation 2020; 104:2582-2590. [DOI: 10.1097/tp.0000000000003183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Jain MD, Lam R, Liu Z, Stubbins RJ, Kahlon A, Kansara R, Goswami R, Humar A, Prica A, Sehn LH, Slack GW, Crump M, Savage KJ, Peters AC, Kuruvilla J. Failure of rituximab is associated with a poor outcome in diffuse large B cell lymphoma‐type post‐transplant lymphoproliferative disorder. Br J Haematol 2020; 189:97-105. [DOI: 10.1111/bjh.16304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/23/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Michael D. Jain
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
- H. Lee Moffitt Cancer Center University of South Florida Morsani College of Medicine Tampa FL USA
| | - Ryan Lam
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
| | - Zhihui Liu
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
| | - Ryan J. Stubbins
- Cross Cancer Institute University of Alberta Edmonton Canada
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - Amrit Kahlon
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - Roopesh Kansara
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
- Cancer Care Manitoba Winnipeg Canada
| | - Rashmi Goswami
- Sunnybrook Research Institute and Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Canada
| | - Atul Humar
- Toronto General Hospital University Health Network University of Toronto Toronto Canada
| | - Anca Prica
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
| | - Laurie H. Sehn
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - Graham W. Slack
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
| | - Michael Crump
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
| | - Kerry J. Savage
- British Columbia Cancer Centre for Lymphoid Cancer Vancouver Canada
| | | | - John Kuruvilla
- Princess Margaret Cancer Centre University Health Network University of Toronto Toronto Canada
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7
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Ballova V, Muoio B, Albano D, Bertagna F, Canziani L, Ghielmini M, Ceriani L, Treglia G. Diagnostic Performance of 18F-FDG PET or PET/CT for Detection of Post-Transplant Lymphoproliferative Disorder: A Systematic Review and a Bivariate Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10020101. [PMID: 32059610 PMCID: PMC7168294 DOI: 10.3390/diagnostics10020101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Some studies evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography or positron emission tomography/computed tomography (PET or PET/CT) for the detection of post-transplant lymphoproliferative disorder (PTLD). As there is no clear consensus about the diagnostic accuracy of these imaging methods, we performed a meta-analysis on this topic. METHODS A comprehensive computer literature search of PubMed, Embase, and Cochrane library databases through December 2019 was performed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) of 18F-FDG PET or PET/CT for detection of PTLD were calculated. RESULTS Five studies reporting data on the diagnostic performance of 18F-FDG PET or PET/CT in 336 transplant recipients were included in the systematic review and bivariate meta-analysis. Pooled sensitivity and specificity for detection of PTLD were 89.7% (95% confidence interval (95%CI): 84.6-93.2%) and 90.9% (95%CI: 85.9-94.3%), respectively. Pooled LR+, LR-, and DOR were 8.9 (95%CI: 5.7-14), 0.13 (95%CI: 0.08-0.2), and 70.4 (95%CI: 35.4-140), respectively. A significant heterogeneity among studies was not detected. CONCLUSIONS Despite limited literature data, 18F-FDG PET or PET/CT demonstrated good diagnostic performance for the detection of PTLD, but large prospective studies are needed to strengthen these findings.
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Affiliation(s)
- Veronika Ballova
- Department of Oncology and Hematology, Cantonal Hospital Baden, CH-5404 Baden, Switzerland;
| | - Barbara Muoio
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland;
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, IT-25123 Brescia, Italy; (D.A.); (F.B.)
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, IT-25123 Brescia, Italy; (D.A.); (F.B.)
| | - Luca Canziani
- Department of Haematology and Oncology, Niguarda Hospital, IT-20162 Milan, Italy;
| | - Michele Ghielmini
- Academic Education Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), CH-6900 Lugano, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland
- Institute of Oncology Research, CH-6500 Bellinzona, Switzerland
| | - Giorgio Treglia
- Academic Education Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland;
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Lausanne and Lausanne University Hospital, CH-1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-918-118-919
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8
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18F-FDG PET/CT in patients with post-transplant lymphoproliferative disorders: so far so good. Eur J Nucl Med Mol Imaging 2019; 47:523-524. [PMID: 31485683 DOI: 10.1007/s00259-019-04518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
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9
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Montes de Jesus FM, Kwee TC, Kahle XU, Nijland M, van Meerten T, Huls G, Dierckx RAJO, Rosati S, Diepstra A, van der Bij W, Verschuuren EAM, Glaudemans AWJM, Noordzij W. Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield. Eur J Nucl Med Mol Imaging 2019; 47:529-536. [PMID: 31444510 PMCID: PMC7005092 DOI: 10.1007/s00259-019-04481-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023]
Abstract
Purpose Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ and hematopoietic stem cell transplantation, requiring a timely and accurate diagnosis. In this study, we evaluated the diagnostic performance of FDG-PET/CT in patients with suspected PTLD and examined if lactate dehydrogenase (LDH) levels, Epstein-Barr virus (EBV) load, or timing of FDG-PET/CT relate to detection performance of FDG-PET/CT. Methods This retrospective study included 91 consecutive patients with clinical suspicion of PTLD and a total of 97 FDG-PET/CT scans within an 8-year period. Pathology reports and a 2-year follow-up were used as the reference standard. Diagnostic performance of FDG-PET/CT for detection of PTLD as well as logistic regression analysis for factors expected to affect diagnostic yield were assessed. Results The diagnosis of PTLD was established in 34 patients (35%). Fifty-seven FDG-PET/CT scans (59%) were true negative, 29 (30%) were true positive, 6 (6%) false positive, and 5 (5%) false negative. Sensitivity of FDG-PET/CT for the detection of PTLD was 85%, specificity 90%, positive predictive value 83%, and negative predictive value 92%, with good inter-observer variability (k = 0.78). Of the parameters hypothesized to be associated with a true positive FDG-PET/CT result for the diagnosis of PTLD, only LDH was statistically significant (OR 1.03, p = 0.04). Conclusion FDG-PET/CT has a good diagnostic performance in patients suspected of PTLD, with a good inter-observer agreement. Only LDH levels seemed to influence the detection performance of FDG-PET/CT. EBV-DNA load and timing of FDG-PET/CT after transplantation did not affect FDG-PET/CT diagnostic yield.
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Affiliation(s)
- F M Montes de Jesus
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands.
| | - T C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - X U Kahle
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T van Meerten
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Huls
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
| | - S Rosati
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W van der Bij
- Department of Pulmonary Diseases and tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E A M Verschuuren
- Department of Pulmonary Diseases and tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
| | - W Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
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