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Choi S, Hong KT, Choi JY, Ahn HY, Ko JS, Suh KS, Park SH, Cheon JE, Shin HY, Kang HJ. Stage IV Classical Hodgkin Lymphoma-type Posttransplant Lymphoproliferative Disorder in a Pediatric Liver Transplant Patient: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2021; 43:e1015-e1019. [PMID: 33769384 DOI: 10.1097/mph.0000000000002121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of diseases with abnormal proliferation of lymphoid tissue and classical Hodgkin lymphoma (CHL) type PTLD is a very rare subtype. We describe a successfully diagnosed and treated CHL-PTLD stage IV pediatric patient, 8 years after liver transplantation. The patient was treated with standard CHL (Children's Cancer Group 5942 group 3) chemotherapy, rituximab and reduction of immunosuppressant. The patient remains in complete remission after 3 years with stable graft function. To our best knowledge, this is the first pediatric case report of a successfully treated stage IV CHL-PTLD after a liver transplant.
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Affiliation(s)
| | - Kyung Taek Hong
- Departments of Pediatrics
- Seoul National University Cancer Research Institute, Seoul
| | - Jung Yoon Choi
- Departments of Pediatrics
- Seoul National University Cancer Research Institute, Seoul
| | | | | | | | | | - Jung-Eun Cheon
- Radiology, Seoul National University College of Medicine
| | - Hee Young Shin
- Departments of Pediatrics
- Seoul National University Cancer Research Institute, Seoul
| | - Hyoung Jin Kang
- Departments of Pediatrics
- Seoul National University Cancer Research Institute, Seoul
- Wide River Institute of Immunology, Hongcheon-gun, Republic of Korea
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2
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Stubbins RJ, Mabilangan C, Rojas-Vasquez M, Lai RL, Zhu J, Preiksaitis JP, Peters AC. Classic Hodgkin lymphoma post-transplant lymphoproliferative disorders (PTLD) are often preceded by discordant PTLD subtypes. Leuk Lymphoma 2020; 61:3319-3330. [PMID: 32878528 DOI: 10.1080/10428194.2020.1808206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Classic Hodgkin lymphoma (CHL) is the rarest post-transplant lymphoproliferative disorder (PTLD) subtype. Few cases of patients with metachronous discordant PTLD episodes including CHL-PTLD have been reported, but the incidence of and risk factors for this phenomenon are unknown. Patients with CHL-PTLD were identified from an institutional PTLD database. Of 13 patients identified with CHL-PTLD six (46%) had antecedent non-CHL-PTLD: three had polymorphic PTLD, two monomorphic PTLD, and one nondestructive PTLD. Patients with prior metachronous non-CHL-PTLD were younger at transplant and had a longer latency time to CHL-PTLD post-transplant. The prevalence of EBV seronegativity at transplant was high in both groups, but prolonged high-level EBV DNAemia only occurred in some with metachronous non-CHL-PTLD. In conclusion, patients with CHL-PTLD have metachronous non-CHL-PTLD diagnoses with discordant histology more commonly than previously recognized. Primary EBV infection with chronically elevated EBV viral loads may represent unique risk factors for CHL-PTLD following an initial non-CHL-PTLD event.
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Affiliation(s)
- Ryan J Stubbins
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Curtis Mabilangan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marta Rojas-Vasquez
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Raymond L Lai
- Department of Pathology and Laboratory Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - James Zhu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - Jutta P Preiksaitis
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anthea C Peters
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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3
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Kumata H, Nakanishi C, Murakami K, Miyagi S, Fukuhara N, Carreras J, Nakamura N, Ichinohasama R, Unno M, Kamei T, Sasano H. Classical Hodgkin lymphoma-type and monomorphic-type post-transplant lymphoproliferative disorder following liver transplantation: a case report. Surg Case Rep 2018; 4:72. [PMID: 29980871 PMCID: PMC6035123 DOI: 10.1186/s40792-018-0480-x] [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: 04/15/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication that can be difficult to treat; moreover, determination of the pathophysiological type is difficult. We report a rare case of a patient who developed two types of Epstein-Barr virus (EBV)-negative PTLD following living donor liver transplantation (LDLT). CASE PRESENTATION A 64-year-old man underwent LDLT for acute fulminant hepatitis B. Sixty-five months later, he developed EBV-negative monomorphic B cell PTLD. Reduction of immunosuppressive therapy and chemotherapy with rituximab resulted in a partial response. He received radioimmunotherapy with yttrium-90-ibritumomab tiuxetan, which was effective for all lesions, except for the splenic hilar lesion, which enlarged and seemed to penetrate the stomach. Therefore, he underwent resection of the pancreatic tail with splenectomy and partial gastrectomy. The pathological diagnosis was EBV-negative classical Hodgkin lymphoma (cHL)-type PTLD. CONCLUSIONS This patient showed an unexpected course of PTLD, from both a clinical and pathological perspective. There are no prior reports of an adult case of EBV-negative cHL-type PTLD coexisting with EBV-negative monomorphic B cell PTLD. When a strange and refractory lesion persists despite effective therapy for PTLD, we must consider the possibility of another type of PTLD within the residual lesion.
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Affiliation(s)
- Hiroyuki Kumata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Ryo Ichinohasama
- Division of Hematopathology, Tohoku University Hospital, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
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Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall. Int J Hematol 2018; 108:218-227. [PMID: 29380181 DOI: 10.1007/s12185-018-2410-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 02/06/2023]
Abstract
We report a case of classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder (HL-PTLD) after kidney transplantation to highlight the difficulty of distinguishing this disorder from Hodgkin lymphoma-like PTLD (HL-like PTLD). Through this case report and literature review, we seek to clarify definitive pathologic features to differentiate these two conditions. A 38-year-old male kidney transplant recipient who had been receiving immunosuppressants was admitted to our hospital with unidentified high fever. Computed tomography images and blood tests indicated a lymphoproliferative disorder. Abdominal lymph node biopsy was performed, and microscopic examination revealed the presence of many large atypical cells in a background of dense T cell accumulation. The large, atypical cells were positive for Epstein-Barr Virus (EBV)-encoded small RNAs (EBER) in situ hybridization, EBV-LMP1, CD30 and PAX5, but negative for CD15, CD20 and CD45. Except for CD15-negativity, this immunohistochemical pattern was consistent with that of classical Hodgkin lymphoma. By close examination of the above immunoreactivities and the patient's subsequent chemosensitive clinical course, we finally made a diagnosis of HL-PTLD.
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Kampers J, Orjuela-Grimm M, Schober T, Schulz TF, Stiefel M, Klein C, Körholz D, Mauz-Körholz C, Kreipe H, Beier R, Maecker-Kolhoff B. Classical Hodgkin lymphoma-type PTLD after solid organ transplantation in children: a report on 17 patients treated according to subsequent GPOH-HD treatment schedules. Leuk Lymphoma 2016; 58:633-638. [DOI: 10.1080/10428194.2016.1205742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Johanna Kampers
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Manuela Orjuela-Grimm
- Pediatric Oncology Hematology & Stem Cell Transplantation, Columbia University Medical Center, New York, NY, USA
| | - Tilmann Schober
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
- Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas F. Schulz
- Institute of Virology, Hannover Medical School, Hannover, Germany
| | - Martina Stiefel
- Center of Pediatrics, University of Halle/Saale, Halle, Germany
| | - Christoph Klein
- Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Dieter Körholz
- Pediatric Hematology and Oncology, Department of Pediatrics, Justus Liebig University of Gießen, Gießen, Germany
| | - Christine Mauz-Körholz
- Pediatric Hematology and Oncology, Department of Pediatrics, Justus Liebig University of Gießen, Gießen, Germany
- Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Rita Beier
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
- Pediatric Hematology and Oncology, Department for Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Britta Maecker-Kolhoff
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover, Germany
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Rosenberg AS, Klein AK, Ruthazer R, Evens AM. Hodgkin lymphoma post-transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival. Am J Hematol 2016; 91:560-5. [PMID: 26928381 PMCID: PMC6586231 DOI: 10.1002/ajh.24346] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 12/21/2022]
Abstract
Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL-PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL-SEER). Overall survival (OS) and disease-specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL-PTLD diagnosis was 88 months. When compared with HL-SEER, patients with HL-PTLD were older (median age, 52 vs. 36 years, P = 0.001), more likely male (73% vs. 54%, P < 0.001), Caucasian (81% vs. 70%, P = 0.02), and had extranodal disease (42% vs. 3%, P < 0.001). Five-year OS for patients with HL-PTLD was 57% versus 80% for HL-SEER (P < 0.001); DSS was also inferior (P < 0.001). For patients with HL-PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR = 0.36, P < 0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR = 2.94, P = 0.001 and 2.01, P = 0.04) versus HL-specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR = 1.26/decade P < 0.001 and 1.64/0.1 mg/dL increase P = 0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10-year OS rates of 79%, 53%, and 11%, respectively (P < 0.001). Altogether, HL-PTLD patients have inferior survival when compared with HL-SEER. Furthermore, treatment with HL-specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival. Am. J. Hematol. 91:560-565, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aaron S. Rosenberg
- University of California Davis School of Medicine, Sacramento, California
- Division of Hematology/Oncology, University of California Davis Medical Center, Sacramento, California
| | - Andreas K. Klein
- Division of Hematology/Oncology, Tufts University Medical Center, Boston, MA
- Tufts Medical School, Boston, MA
| | - Robin Ruthazer
- Tufts Medical School, Boston, MA
- Tufts Clinical and Translational Science Institute, Boston, MA
| | - Andrew M. Evens
- Division of Hematology/Oncology, Tufts University Medical Center, Boston, MA
- Tufts Medical School, Boston, MA
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7
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Guimarães AC, de Carvalho GM, Correa CRS, Gusmão RJ. Association between unilateral tonsillar enlargement and lymphoma in children: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2015; 93:304-11. [DOI: 10.1016/j.critrevonc.2014.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 01/06/2023] Open
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Guimarães AC, de Carvalho GM, Bento LR, Correa C, Gusmão RJ. Clinical manifestations in children with tonsillar lymphoma: A systematic review. Crit Rev Oncol Hematol 2014; 90:146-51. [DOI: 10.1016/j.critrevonc.2013.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 12/17/2022] Open
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9
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Basso S, Zecca M, Calafiore L, Rubert L, Fiocchi R, Paulli M, Quartuccio G, Guido I, Sebastiani R, Croci GA, Beschi C, Nardiello I, Ginevri F, Cugno C, Comoli P. Successful treatment of a classic Hodgkin lymphoma-type post-transplant lymphoproliferative disorder with tailored chemotherapy and Epstein-Barr virus-specific cytotoxic T lymphocytes in a pediatric heart transplant recipient. Pediatr Transplant 2013; 17:E168-73. [PMID: 23992468 DOI: 10.1111/petr.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/14/2022]
Abstract
CHL type is the least common major form of EBV-related PTLD but rarely occurs in pediatric recipients; development of CHL subsequent to other PTLD subtypes in the same transplant recipient is even more unusual. Because of its rarity, indications on the best treatment strategy are limited. Patients have been mostly treated with standard HL chemotherapy/radiotherapy, and prognosis seems more favorable than other monomorphic PTLDs. Herein, we describe a pediatric case of EBV-associated, stage IV-B, CHL arising in a heart allograft recipient eight yr after diagnosis of B-cell polymorphic PTLD. The patient was successfully treated with adjusted-dose HL chemotherapy and autologous EBV-specific CTL, without discontinuation of maintenance immunosuppression. At two yr from therapy completion, the patient is in CR with stable organ function. With this strategy, it may be possible to reproduce the good prognostic data reported for CHL-type PTLD, with decreased risk of organ toxicity or rejection.
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Affiliation(s)
- Sabrina Basso
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Khedmat H, Ghamar-Chehreh ME, Amini M, Taheri S. More benign lymphoproliferative disease after liver transplant in infants. Prog Transplant 2013; 23:158-64. [PMID: 23782664 DOI: 10.7182/pit2013425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT-Despite the high frequency of liver transplants in infants, few data are available on the characteristics of posttransplant lymphoproliferative disorders in liver transplant patients (PTLD). OBJECTIVE-To analyze special features and behavior of PTLD arising after liver transplant in infants. METHODS-A comprehensive search of the literature was conducted for the available data on PTLD in infant liver transplant recipients through PubMed and Google scholar. An infant was defined as a liver recipient who was less than 2 years old at the time of transplant. Overall, 205 cases of PTLD were found in 24 reports, and the 100 infants with PTLD were compared with children and adults with PTLD. RESULTS-PTLD lesions in infants were more likely to be polymorphic whereas monomorphic lesions were more prevalent among older patients (P= .05). Remission rates, metastasis frequency, and organ involvement did not differ significantly between the groups. Survival analysis showed that the infants had a significantly better outcome than did older patients (P= .05). CONCLUSION-PTLD is more benign and may have a better outcome in infant liver transplant recipients than in older recipients. A prospective multicenter approach is needed for future research studies.
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Khedmat H, Taheri S. Lymphoproliferative disorders in pediatric liver allograft recipients: a review of 212 cases. Hematol Oncol Stem Cell Ther 2012; 5:84-90. [DOI: 10.5144/1658-3876.2012.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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12
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Subsequent development of diffuse large B-cell lymphomas and Hodgkin lymphoma associated with primary immune disorder in a 6-year-old female: a case report and review of the literature. J Pediatr Hematol Oncol 2011; 33:e320-5. [PMID: 21572347 DOI: 10.1097/mph.0b013e318207a37a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neoplastic lymphoid proliferation may arise from immune deficiency or disordered regulation of the immune system. Often the neoplasms are associated with viral agents, such as Epstein-Barr virus, human immunodeficiency virus, or human herpes virus 8. Lymphoproliferative diseases have been documented in a variety of primary immune disorders. The most commonly encountered neoplastic lesion is diffuse large B-cell lymphoma (DLBCL), although Hodgkin lymphoma (HL), Burkitt lymphoma, and peripheral T-cell lymphomas and/or leukemias have also been documented in rare instances. We report a case of a 6-year-old girl with unclassifiable primary immunodeficiency diagnosed with 2 different clones of DLBCLs and subsequently developed lymphocyte-depleted, classical HL. Both neoplasms were associated with Epstein-Barr virus. To the best of our knowledge, this is the first reported occurrence of primary immune disorder-associated lymphoproliferative disease with sequential development of DLBCLs and HL in a pediatric patient. Thorough surveillance is paramount for accurate assessment of the associated lymphoproliferative disease and in ascertaining likely transformation to, or de novo evolution of a different lymphoid neoplasm. This is also important in evaluating treatment response with appropriate therapeutic adjustments if clinically indicated.
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Abstract
Post-transplant hemopathies are a serious complication of organ transplantation. They include several entities: non-hodgkin lymphoma, Hodgkin disease and myeloma. The pathophysiology, clinical and histological features, treatment and evolution of these diseases are different, but share some similarities. Among factors involved in lymphomagenesis, the role of Epstein Barr virus and immunosuppression are central. EBV primo-infection or reactivation together with a deep depression of T-cell immunity is at particular risk of lymphoma development. The clinical expression and outcome of lymphomas are varied. Assays for EBV replication quantification have been developed leading to immunosuppression decreasing and antiviral therapy when the replication increases. Treatment of post-transplant lymphoproliferations consists mainly in immunotherapy and chemotherapy. Hodgkin disease and myeloma are rare after transplantation; their management is close to the one of immunocompetent patients. The recurrence of myeloma, amyloidosis or light chain deposition disease seems frequent after transplantation and only patients with disappearance of monoclonal component should be proposed for transplantation. On the opposite, the risk of recurrence appears lower for Hodgkin disease; therefore the transplantation of patients with a history of Hodgkin disease looks possible.
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Ohta H, Fukushima N, Ozono K. Pediatric post-transplant lymphoproliferative disorder after cardiac transplantation. Int J Hematol 2009; 90:127-136. [DOI: 10.1007/s12185-009-0399-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/19/2009] [Accepted: 07/23/2009] [Indexed: 11/28/2022]
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Krishnamurthy S, Hassan A, Frater JL, Paessler ME, Kreisel FH. Pathologic and clinical features of Hodgkin lymphoma--like posttransplant lymphoproliferative disease. Int J Surg Pathol 2009; 18:278-85. [PMID: 19578050 DOI: 10.1177/1066896909338597] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Because of its rarity, pathologic and clinical features of Hodgkin lymphoma-like posttransplant lymphoproliferative disorder (HL-like PTLD) are not well understood, and it is unclear whether its biological behavior is more closely related to classical Hodgkin disease or to monomorphic B-cell PTLD. The authors compared 6 cases of HL-like PTLD with 5 cases of monomorphic B-cell PTLD for differences in histology, immunophenotype, and clinical behavior. Histologically, all cases of HL-like PTLD resembled classical HL with typical Reed-Sternberg (RS) cells and a cellular background mimicking mixed cellularity subtype. CD45 was absent on RS-like cells, but the expression pattern of B-cell-associated markers Oct-2 and BOB.1 resembled monomorphic B-cell PTLD. Whereas Epstein-Barr virus early RNA expression is normally restricted to RS cells of classical HL, it was expressed in both RS-like cells and background lymphocytes in HL-like PTLD. Although all patients diagnosed with monomorphic B-cell PTLD show no evidence of disease following treatment, half of the patients with HL-like PTLD relapsed or died, indicating a more aggressive clinical behavior. The findings suggest that HL-like PTLD represents a distinct clinicopathologic entity with an aggressive clinical course.
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Affiliation(s)
- Smita Krishnamurthy
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, Missouri 63110, USA
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BCL6 expression correlates with monomorphic histology in children with posttransplantation lymphoproliferative disease. J Pediatr Hematol Oncol 2008; 30:684-8. [PMID: 18776761 PMCID: PMC2652168 DOI: 10.1097/mph.0b013e31817eb7ca] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Posttransplantation lymphoproliferative disease (PTLD) is a complication of organ transplantation with high mortality. Predicting response to first-line therapy, reduction of immune suppression, is difficult because of the heterogeneity of lesions and disease behavior. We sought to determine if BCL6 protein expression in PTLD cells is associated with poor outcome. In a cohort of 25 children with PTLD, 9 of the patients' tumor specimens were positive for BCL6 protein expression. Eight of 13 monomorphic lesions were BCL6 positive, compared with 1 of 11 evaluable polymorphic lesions (P=0.01). Only 1 of the patients with BCL6 expression responded to reduced immune suppression (P=0.19). Recipients of heart transplants who developed PTLD had reduced overall survival rates compared with recipients of other organ transplants who developed PTLD (P=0.04).
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Posttransplant Lymphoproliferative Disorder Followed by Hodgkins Disease in a Renal Transplant Recipient. Transplantation 2008; 85:1219-20. [DOI: 10.1097/tp.0b013e31816b3e35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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