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Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant. J Clin Med 2022; 11:jcm11237058. [PMID: 36498633 PMCID: PMC9739215 DOI: 10.3390/jcm11237058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/12/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorders (PTLD) are rare immunosuppression complications affecting 5% of transplant patients. Isolated central nervous system (CNS)-PTLD without nodal or extra-nodal organ involvement is rarely reported and is difficult to diagnose due to the non-specific clinical manifestations and imaging features overlapping with other common CNS lesions. CASE PRESENTATION We present a case of a 72-year-old female subjected to a renal transplant 11 years ago with progressively worsening headaches and confusion. Imaging revealed vasogenic edema in the left frontal and bilateral temporal lobes. She was subjected to a craniotomy and excisional biopsy to obtain tissue for diagnostic and therapeutic interventions. Pathology examination showed atypical EBV-positive lymphoplasmacytic infiltrate, consistent with Polymorphic type PTLD. CONCLUSIONS Patients diagnosed with PTLD need to have close monitoring of immunosuppressive medications while in the hospital. Early diagnosis is essential for patient survival with PTLD, as their health can deteriorate fast.
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2
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Wang Z, Xu Y, Zhao J, Fu YX. Epstein-Barr virus-associated monomorphic post-transplant lymphoproliferative disorder after pediatric kidney transplantation: A case report. World J Clin Cases 2021; 9:469-475. [PMID: 33521117 PMCID: PMC7812878 DOI: 10.12998/wjcc.v9.i2.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disease (PTLD) is the most common malignant tumor that occurs after kidney transplantation in children, and is associated with Epstein-Barr virus (EBV).
CASE SUMMARY We report a case of PTLD that occurred in a 17-year-old female patient at 5 mo post-transplant. The first symptom was abdominal pain accompanied by fever, nausea, and vomiting. EBV-associated monomorphic PTLD with multiple abdominal nodules was diagnosed by pathology, clinical manifestations, imaging results, and the presence of EB-DNA. After successful treatment with rituximab, the abdominal nodules in the spleen and liver disappeared.
CONCLUSION Early pathological biopsy to confirm the diagnosis is critical to treatment and prognosis. Reducing immunosuppression and rituximab therapy are effective methods for treating PTLD, but need to be initiated as early as possible.
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Affiliation(s)
- Zhen Wang
- Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
| | - Yang Xu
- Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
| | - Jie Zhao
- Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
| | - Ying-Xin Fu
- Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
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3
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Voorhees TJ, Kannan KK, Galeotti J, Grover N, Vaidya R, Moore DT, Montgomery ND, Beaven AW, Dittus C. Identification of high-risk monomorphic post-transplant lymphoproliferative disorder following solid organ transplantation. Leuk Lymphoma 2020; 62:86-94. [PMID: 32933363 DOI: 10.1080/10428194.2020.1821006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Monomorphic post-transplant lymphoproliferative disorder (M-PTLD) occurring after solid organ transplant histologically resembles aggressive non-Hodgkin lymphomas, with diffuse large B-cell lymphoma being the most common. In a cohort of 40 patients with DLBCL-type M-PTLD, inferior progression free survival (PFS) was observed for Revised International Prognostic Index (R-IPI) >2 (p = 0.01) and high-risk pathologic features (p = 0.02), defined by double expressor lymphoma, MYC rearrangement, or increased copy number of either MYC or BCL2. Overall survival (OS) was inferior in R-IPI >2 (p = 0.002) and high-risk pathologic features (p = 0.003). Combining both R-IPI >2 and high-risk pathologic features resulted in well-delineated good, intermediate, and poor risk groups of DLBCL-type M-PTLD with respect to both PFS and OS (p < 0.001). Our results demonstrate a prognostic role for both the R-IPI score and presence of high-risk pathologic features in DLBCL-type M-PTLD.
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Affiliation(s)
- Timothy J Voorhees
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kavya K Kannan
- Division of Hematology and Oncology, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Natalie Grover
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rakhee Vaidya
- Division of Hematology and Oncology, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Dominic T Moore
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Anne W Beaven
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Dittus
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
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4
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Bosse RC, Franke AJ, Paul Skelton W, Woody LE, Bishnoi R, Wang Y, Bhaduri-McIntosh S, Rajderkar D, Shih R, Dang NH, Slayton WB. Post Transplant Lymphoproliferative Disorder risk factors in children: Analysis of a 23-year single-institutional experience. Pediatr Transplant 2020; 24:e13747. [PMID: 32497335 DOI: 10.1111/petr.13747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION PTLD is the most frequent malignancy following SOT in children and the second most common SOT complication in adults. However, factors determining outcomes in children are poorly understood due to its relative rarity. METHODS This study was performed at the University of Florida. Univariate and multivariate analyses were used to identify prognostic factors in pediatric patients diagnosed with PTLD. RESULTS We reviewed records of 54 pediatric (younger than 18 years old at diagnosis) patients diagnosed with PTLD from 1994 to 2017. The median follow-up was 28.8 months. The estimated 5-year survival rate was 87.6% (95% CI 74.3-94.2%). Univariate analysis showed that organ transplanted (specifically heart transplant), poor response to initial treatment, allograft rejection, and low Karnofsky score were statistically significant for negative prognostic factors in determining survival. Multivariate analysis determined progression in response to initial treatment and presence of allograft rejection as statistically significant prognostic factors affecting overall survival. We found no statistically significant impact of EBV serological status on PTLD prognosis. CONCLUSIONS Disease progression and allograft rejection were strong negative prognostic indicators in our study cohort. Close attention to graft status and development of therapies that protect the graft from rejection while bolstering anti-EBV immunity will be essential to further improving PTLD outcomes in children.
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Affiliation(s)
- Raphael C Bosse
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aaron J Franke
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Hematology/Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Gainesville, Florida, USA
| | - William Paul Skelton
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Hematology/Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Gainesville, Florida, USA
| | - Lindsey E Woody
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rohit Bishnoi
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yu Wang
- Division of Quantitative Science, UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Sumita Bhaduri-McIntosh
- Division of Infectious Diseases, Departments of Pediatrics and of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, USA
| | - Dhanashree Rajderkar
- Division of Pediatric Radiology, Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Nam H Dang
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - William B Slayton
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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5
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Late-Onset Posttransplant Lymphoproliferative Disorders after Solid Organ Transplantation in Adults: A Case Series and Review of the Literature. Case Rep Transplant 2020; 2020:8247308. [PMID: 32095310 PMCID: PMC7035525 DOI: 10.1155/2020/8247308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/21/2020] [Indexed: 01/20/2023] Open
Abstract
The posttransplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of neoplasms that have wide variety of clinical and histological presentations. The management of PTLDs is challenging due to variety of involvement sites and histological types. The length and type of immunosuppression are correlated with the emergence of PTLDs, and most of the cases appear within the first two years after transplant. This case series describes five late-onset PTLDs with rare histological features and multiorgan involvement.
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6
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Mazanowska O, Donizy P, Kuźmińska J, Roczek K, Zimny A, Banasik M, Kaminska D, Hap K, Klinger M, Halon A. Acute Brain Damage in a 56-Year-Old Woman With a 20-Year-Old Transplanted Kidney as a Complicated Differential Diagnostic Process: A Case Report. Transplant Proc 2018; 50:1914-1918. [PMID: 30056928 DOI: 10.1016/j.transproceed.2018.02.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Acute central nervous system (CNS) damage in a patient who has received organ transplant is an extremely difficult and complex clinical issue that spans a wide spectrum of differential diagnoses with ischemia, post-transplant lymphoproliferative disorders (PTLDs), infections, lymphomas, and progressive multifocal leukoencephalopathy (PML). PTLDs are a clinically and histopathologically heterogeneous group of diseases that most often occur in heavily immunocompromised populations after solid organ transplantation (SOT), probably related to the infection or reactivation of Epstein-Barr virus (EBV) infection, whereas PML is an infectious disease caused by the John Cunningham virus (JCV). CASE DESCRIPTION A 56-year-old female, 20 years after renal transplantation from a deceased donor, was admitted to the hospital as an emergency due to sensory aphasia and memory disorders. Computed tomography (CT) examination revealed a diffuse expansive process in the temporo-parieto-occipital and left frontal area. Magnetic resonance imaging (MRI) results suggested changes associated with PML; however, JCV was not found in the cerebrospinal fluid. The disorders progressed quickly, both clinically and radiologically-the patient developed central facial palsy, paresis of limbs, and positive Babinski sign on the left. A second radiological examination (CT) also suggested PML. Due to the rapid deterioration of the patient's general condition, further diagnostic examinations (magnetic resonance with contrast and brain stereotactic biopsy) could not be performed. After almost 2 months of the commencement of the diagnostic process, the patient died. Autopsy revealed that the cause of death was acute CNS damage in the course of monomorphic PTLD (CNS-PTLD). CONCLUSION Rapid deterioration of mental status can be the first symptom of CNS-PTLD, a dangerous and life-threatening condition in immunocompromised patients after solid organ transplantation.
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Affiliation(s)
- O Mazanowska
- Faculty of Medicine and Dentistry, Wroclaw Medical University, Department of Nephrology and Transplantation Medicine, Wroclaw, Poland.
| | - P Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - J Kuźmińska
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - K Roczek
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - A Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - M Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - D Kaminska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - K Hap
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - M Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - A Halon
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
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7
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Bishnoi R, Bajwa R, Franke AJ, Skelton WP, Wang Y, Patel NM, Slayton WB, Zou F, Dang NH. Post-transplant lymphoproliferative disorder (PTLD): single institutional experience of 141 patients. Exp Hematol Oncol 2017; 6:26. [PMID: 29021921 PMCID: PMC5622441 DOI: 10.1186/s40164-017-0087-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/20/2017] [Indexed: 02/08/2023] Open
Abstract
Background Post-transplant lymphoproliferative disorder is a well-recognized but rare complication of hematopoietic stem cell and solid organ transplant. Due to rarity of this disease, retrospective studies from major transplant centers has been the main source to provide treatment guidelines, which are still in evolution. The sample size of this study is among one of the largest study on PTLD till date reported throughout the world. Methods This study was performed at University of Florida which is one of the largest transplant center in South East United States. We performed treatment and survival analysis along with univariate and multivariate analysis to identify prognostic factors. Results We reviewed 141 patients diagnosed with PTLD over last 22 years with median follow-up of 2.4 years. The estimated median overall survival of the entire group was 15.0 years. Sub group analysis showed that 5-year overall survival rates of pediatric population were 88% (median not reached). For adults, median OS was 5.35 years while for elderly patients it was 1.32 years. The estimated median OS of patients with monomorphic PTLD was 9.0 years while in polymorphic PTLD was 19.3 years. Univariate analysis identified gender, age at transplant and PTLD diagnosis, performance status, IPI score, allograft type, recipient EBV status, multiple acute rejections prior to PTLD diagnosis, PTLD sub-type, extra-nodal site involvement, immunosuppressive drug regimen at diagnosis, initial treatment best response were statistically significant prognostic factors (p < 0.05). On multivariate analysis, age at PTLD diagnosis, recipient EBV status, bone marrow involvement, and initial best response were statistically significant prognostic factors (p < 0.05). Surprisingly, use of Rituximab alone as upfront therapy had poor hazard ratio in the cumulative group as well less aggressive PTLD subgroup comprising of early lesions and polymorphic PTLD. Conclusions Our experience with treatment and analysis of outcomes does challenge current role of Rituximab use in treatment of PTLD. Currently as we define role of immunotherapy in cancer treatment, the role of acute rejections and immunosuppressant in PTLD becomes more relevant as noticed in our study. This study was also able to find new prognostic factors and also verified other known prognostic factors.
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Affiliation(s)
- Rohit Bishnoi
- Department of Medicine, University of Florida, PO Box 100238, Gainesville, FL 32610-0238 USA
| | - Ravneet Bajwa
- Department of Medicine, University of Florida, PO Box 100278, 1600 SW Archer Rd, Gainesville, FL 32610 USA
| | - Aaron J Franke
- Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL 32610-0277 USA
| | - William Paul Skelton
- Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL 32610-0277 USA
| | - Yu Wang
- Department of Biostatistics, University of Florida, PO Box 117450, Gainesville, FL 32611 USA
| | - Niraj M Patel
- Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL 32610-0277 USA
| | - William Birdsall Slayton
- Division of Pediatric Hematology/Oncology, University of Florida, PO Box 100298, Gainesville, FL 32610-0298 USA
| | - Fei Zou
- Department of Biostatistics, University of Florida, PO Box 117450, Gainesville, FL 32611 USA
| | - Nam H Dang
- Department of Medicine, University of Florida, PO Box 100278, 1600 SW Archer Rd, Gainesville, FL 32610 USA
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8
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Ishihara H, Shimizu T, Unagami K, Hirai T, Toki D, Omoto K, Okumi M, Imai Y, Ishida H, Tanabe K. Post-Transplant Lymphoproliferative Disorder in Kidney Transplant Recipients: A Single-Center Experience in Japan. Ther Apher Dial 2016; 20:165-73. [DOI: 10.1111/1744-9987.12392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/07/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | | | - Kohei Unagami
- Department of Nephrology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Toshihito Hirai
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Daisuke Toki
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Kazuya Omoto
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Masayoshi Okumi
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Yoichi Imai
- Department of Hematology; Tokyo Women's Medical University; Tokyo Japan
| | - Hideki Ishida
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology, Kidney Center; Tokyo Women's Medical University; Tokyo Japan
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9
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Morton M, Coupes B, Ritchie J, Roberts SA, Klapper PE, Byers RJ, Vallely PJ, Ryan K, Picton ML. Post-transplant lymphoproliferative disorder in adult renal transplant recipients: survival and prognosis. Leuk Lymphoma 2016; 57:299-305. [PMID: 25976109 DOI: 10.3109/10428194.2015.1050391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a rare, serious complication following solid organ transplantation, with an incidence of 2.6 cases per 1000 patient years. Optimal treatment strategies and risk stratifications specific to kidney transplantation are lacking and PTLD mortality remains high. This study investigated survival and prognosis in 89 cases of PTLD presenting over 44 years at Manchester Royal Infirmary. Patient survival following diagnosis was 72% at 6 months, 67% at 1 year and 54% at 3 years. In multivariate analysis, a poorer 3 year survival was associated with acute kidney injury at diagnosis (p = 0.0001), impaired renal function (p = 0.04), early onset (p = 0.02), T cell disease (p = 0.02) and previous treatment with anti-thymocyte globulin (p = 0.04). The inclusion of graft function adds prognostic value to risk stratification and should be explored further. Strategies to improve survival should include timing and choice of immuno-chemotherapy, preparation for dialysis and aggressive surveillance for sepsis and treatment toxicity.
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Affiliation(s)
- Muir Morton
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - Beatrice Coupes
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - James Ritchie
- b Center for Epidemiology, Institute of Population Health, Salford Royal NHS Foundation Trust , Salford , UK
| | - Stephen A Roberts
- c Centre for Biostatistics, Institute of Population Health, University of Manchester , Manchester , UK
| | - Paul E Klapper
- d Department of Clinical Virology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.,e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK
| | - Richard J Byers
- f Department of Histopathology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.,g School of Cancer and Enabling Sciences, Faculty of Medical and Human Sciences, University of Manchester , Manchester , UK.,h Manchester Academic Health Science Centre , Manchester , UK
| | - Pamela J Vallely
- e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK
| | - Kate Ryan
- h Manchester Academic Health Science Centre , Manchester , UK.,i Department of Haematology , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - Michael L Picton
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
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10
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Thomas de Montpréville V, Le Pavec J, Le Roy Ladurie F, Crutu A, Mussot S, Fabre D, Mercier O, Dorfmuller P, Ghigna MR, Fadel É. Lymphoproliferative Disorders after Lung Transplantation: Clinicopathological Characterization of 16 Cases with Identification of Very-Late-Onset Forms. Respiration 2015; 90:451-459. [PMID: 26506523 DOI: 10.1159/000441064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/11/2015] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The incidence of posttransplant lymphoproliferative disorders (PTLD) has recently declined, but late cases are increasingly reported in lung transplant recipients. OBJECTIVES We present our experience with PTLD after lung transplantation, attempting to examine the distinguishing characteristics of early versus late cases. METHODS We have reviewed clinical and pathological data of all cases occurring in our institution between 2001 and 2014. RESULTS Patients, aged 15-63 years, were mostly (12/16) Epstein-Barr virus (EBV) seropositive at the time of transplantation. Eleven early cases, occurring 9.4 ± 5.2 months after transplantation and mostly (9/11) prior to 2010, had EBV+ diffuse large B-cell lymphomas. Lungs and/or thoracic lymph nodes were often involved (n = 8). Treatments included reduction of immune suppression (n = 11), rituximab (n = 8) and chemotherapy (n = 7). Two patients are in complete remission at 26 and 216 months. Nine patients died 8.0 ± 6.5 months after PTLD diagnosis. Of the 5 cases with late PTLD occurring 4-23 years (mean ± SD: 10.4 ± 7.7) after transplantation (and 3/5 after 2009), 1 had pulmonary lymphomatoid granulomatosis (only endothoracic case), 1 cutaneous large T-cell lymphoma, 2 had anaplastic large cell lymphomas, and 1 Hodgkin's disease. Two of the 5 cases were EBV-, including one followed by a second EBV+ PTLD after 8 years of complete remission. Two patients were alive and well (follow-up: 44 and 151 months), one having suffered from EBV-related cholestatic hepatitis 6 years after the PTLD. CONCLUSION Our small experience shows a trend toward (very) late occurrence, associated with more unusual clinicopathologic features, but not with a worse prognosis.
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11
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Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A. Post-transplant lymphoproliferative disorders: from epidemiology to pathogenesis-driven treatment. Cancer Lett 2015; 369:37-44. [PMID: 26279520 DOI: 10.1016/j.canlet.2015.08.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 02/07/2023]
Abstract
Post-transplant lymphoproliferative disorders (PTLDs) represent the most severe complication of both solid organ and hematopoietic stem cell transplantation. The Epstein-Barr Virus (EBV) is the main driver of PTLD, particularly those occurring early after transplantation. EBV-driven malignancies are associated with selective expression of latent viral proteins, but uncontrolled lytic replication may favor early phases of cell transformation. Besides immunodepression, persistent immune activation and chronic inflammation play an important role in both virus reactivation and expansion of EBV-infected B cells. EBV-induced immortalization requires the expression of telomerase. TERT, the rate-limiting component of the telomerase complex, is central in the switch from the lytic to the latent viral program, and TERT inhibition induces the EBV lytic cycle and cell death. Immunotherapy and combination of EBV lytic cycle inducers with antiviral drugs are promising strategies to improve the treatment of PTLD patients. This review is aimed at providing an update on the intriguing association between EBV and PTLD, mainly focusing on cases arising after kidney and liver transplantation, which account for the vast majority of transplants.
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Affiliation(s)
- Maria Raffaella Petrara
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy; Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Silvia Giunco
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Diego Serraino
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy
| | - Riccardo Dolcetti
- Cancer Bio-Immunotherapy Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy; Viral Oncology Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy.
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12
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Amorim Pellicioli AC, Luciano AA, Rangel ALCA, de Oliveira GR, Santos Silva AR, de Almeida OP, Vargas PA. Epstein-Barr virus (EBV)--associated posttransplant lymphoproliferative disorder appearing as mandibular gingival ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:e80-6. [PMID: 26321430 DOI: 10.1016/j.oooo.2015.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) comprise a spectrum of complications that affect immunocompromised patients following hematopoietic stem cell transplantation or solid organ transplantation. Its incidence varies depending on the transplanted organ, occurring in approximately 2.3% of kidney transplantations. A 31-year-old woman was referred to the Dental Clinic of the State University of Western Paraná for evaluation of an oral lesion. Her medical history revealed a previous diagnosis of hypertension, Epstein-Barr virus (EBV) seropositivity, and kidney transplantation 12 years prior. She was under standard immunosuppressive therapy. Intraoral examination identified a gingival necrotic lesion with extension to the posterior right lower alveolar bone. An incisional biopsy was performed. Histologic examination showed lymphocytic proliferation of cells with small and hyperchromatic nuclei, atypical mitosis, and cells with large and pale nuclei showing prominent nucleoli permeating connective tissue, muscle fibers, and adipocytes. Correlation of clinical, histologic, and immunohistochemical findings led to a diagnosis of polymorphic EBV-associated PTLD rich in B and T cells.
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13
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Snanoudj R, Tinel C, Legendre C. Immunological risks of minimization strategies. Transpl Int 2015; 28:901-10. [DOI: 10.1111/tri.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/17/2014] [Accepted: 03/19/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Renaud Snanoudj
- Université Sorbonne Paris Cité; Paris France
- Service de Néphrologie - Transplantation; Hôpital Necker; Assistance Publique-Hôpitaux de Paris; Paris France
| | - Claire Tinel
- Université Sorbonne Paris Cité; Paris France
- Service de Néphrologie - Transplantation; Hôpital Necker; Assistance Publique-Hôpitaux de Paris; Paris France
| | - Christophe Legendre
- Université Sorbonne Paris Cité; Paris France
- Service de Néphrologie - Transplantation; Hôpital Necker; Assistance Publique-Hôpitaux de Paris; Paris France
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Serre JE, Michonneau D, Bachy E, Noël LH, Dubois V, Suberbielle C, Kreis H, Legendre C, Mamzer-Bruneel MF, Morelon E, Thaunat O. Maintaining calcineurin inhibition after the diagnosis of post-transplant lymphoproliferative disorder improves renal graft survival. Kidney Int 2014; 85:182-90. [DOI: 10.1038/ki.2013.253] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 04/15/2013] [Accepted: 05/09/2013] [Indexed: 12/28/2022]
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