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Morland D, Kanagaratnam L, Hubelé F, Toussaint E, Choquet S, Kas A, Caquot PA, Haioun C, Itti E, Leprêtre S, Decazes P, Bijou F, Schwartz P, Jacquet C, Chauchet A, Matuszak J, Kamar N, Payoux P, Durot E. Cerebellum/liver index on baseline 18F-FDG PET/CT to improve prognostication in post-transplant lymphoproliferative disorders: a multicenter retrospective study. EJNMMI Res 2024; 14:49. [PMID: 38801646 PMCID: PMC11130085 DOI: 10.1186/s13550-024-01111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Besides International Prognostic Index (IPI) score, baseline prognostic factors of post-transplant lymphoproliferative disorders (PTLD) are poorly identified due to the rarity of the disease. New indexes derived from healthy organ uptake in baseline 18F-FDG PET/CT have been studied in immunocompetent lymphoma patients. The aim of this study is to evaluate the performances of the cerebellum-to-liver uptake ratio (denoted as CLIP) as a prognostic factor for PFS and OS. This retrospective multicenter study is based on patients with PTLD included in the K-VIROGREF cohort. The previously published threshold of 3.24 was used for CLIP in these analyses. RESULTS A total of 97 patients was included with a majority of monomorphic diffuse large B-cell lymphoma subtype (78.3%). Both IPI score (≥ 3) and CLIP (< 3.24) were significant risk factors of PFS with corresponding hazard ratios of 2.0 (1.0-4.0) and 2.4 (1.3-4.5) respectively. For OS, CLIP was not significant and resulted in a hazard ratio of 2.6 (p = 0.059). Neither IPI score or Total Metabolic Tumor Volume reached significance for OS. CONCLUSION CLIP is a promising predictor of PFS and perhaps OS in PTLD. Further prospective studies are needed to confirm these results.
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Affiliation(s)
- David Morland
- Médecine Nucléaire, Institut Godinot, Reims, France.
- Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, Reims, France.
- CReSTIC, EA 3804, Université de Reims Champagne-Ardenne, Reims, France.
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Lukshe Kanagaratnam
- Unité d'Aide Méthodologique, Pôle Recherche et Santé Publique, CHU de Reims, Reims, France
| | - Fabrice Hubelé
- Médecine Nucléaire, CHU de Strasbourg, ICANS, Strasbourg, France
| | | | - Sylvain Choquet
- Hématologie, CHU Pitié-Salpêtrière Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Aurélie Kas
- Médecine Nucléaire, CHU Pitié-Salpêtrière Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Pierre-Ambroise Caquot
- Médecine Nucléaire, Institut Godinot, Reims, France
- Médecine Nucléaire, CHU Pitié-Salpêtrière Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | | | - Emmanuel Itti
- Médecine Nucléaire, CHU Henri Mondor, AP-HP, Créteil, France
| | - Stéphane Leprêtre
- Inserm U1245 et Département d'Hématologie, Centre Henri Becquerel et Normandie Univ, UNIROUEN, Rouen, France
| | - Pierre Decazes
- Médecine Nucléaire, Centre Henri Becquerel, Rouen, France
| | | | - Paul Schwartz
- Médecine Nucléaire, Institut Bergonié, Bordeaux, France
| | | | | | | | - Nassim Kamar
- Néphrologie et transplantation d'organes, CHU Rangueil, Toulouse, France
| | - Pierre Payoux
- Médecine Nucléaire, CHU de Toulouse, Toulouse, France
| | - Eric Durot
- Hématologie Clinique, CHU de Reims, Reims, France
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2
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Fleury AS, Zhuang H. FDG PET/CT Findings of Renal Cell Carcinoma Arising From a Transplanted Kidney in a Pediatric Patient. Clin Nucl Med 2023; 48:e605-e607. [PMID: 37844572 DOI: 10.1097/rlu.0000000000004908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
ABSTRACT A 12-year-old girl presented with a history of kidney transplant complicated by posttransplant lymphoproliferative disease. A solid mass was found in the lower pole of the transplanted kidney, concerning for posttransplant lymphoproliferative disease. However, biopsy confirmed papillary renal cell carcinoma. FDG PET/CT showed increased activity in the known renal cell carcinoma in the renal allograft.
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Affiliation(s)
- Anilawan S Fleury
- From the Division of Nuclear Medicine, Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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3
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Chen J, Zhang X, Ma L, Gao Y, Fu Z, Liu M. 18F-FDG PET/CT findings in a patient with blastic plasmacytoid dendritic cell neoplasm and post-transplant lymphoproliferative disorder after hematopoietic stem cell transplantation: a case report. Front Med (Lausanne) 2023; 10:1258310. [PMID: 37663666 PMCID: PMC10469918 DOI: 10.3389/fmed.2023.1258310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare hematopoietic malignancy, which originating from precursors of plasmacytoid dendritic cells. Allogeneic hematopoietic stem cell transplantation (HSCT) is normally considered in the treatment of BPDCN patients to acquire sustained remission. Post-transplant lymphoproliferative disorder (PTLD) is a group of conditions involving abnormal lymphoid cells proliferation in the context of extrinsic immunosuppression after solid organ transplantation (SOT) or HSCT. Herein, we report a patient with BPDCN, who suffered from PTLD after allogeneic HSCT. Case presentation A 66-year-old man was diagnosed with BPDCN, confirmed by pathologic examination after splenectomy. The post-surgery 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG PET/CT) showed multifocal 18F-FDG avidity in the left cheek, lymph nodes and bone marrow. The patient started chemotherapy, followed by allogeneic HSCT and immunosuppressive therapy. Four months after the HSCT, the patient developed intermittent fever and recurrent lymphadenopathy, accompanied with progressively elevated Epstein-Barr virus (EBV)-DNA both in serum and lymphocytes. 18F-FDG PET/CT was performed again and found multiple new enlarged 18F-FDG-avid lymph nodes, while the previous hypermetabolic lesions all disappeared. The pathology of mesenteric lymph node indicated a monomorphic PTLD (diffuse large B-cell lymphoma). Then the immunosuppressive medications were stopped and two cycles of Rituximab were given, and the follow-up CT scan indicated a complete response. Conclusion When patients with BPDCN recurred new enlarged lymph nodes after allogeneic HSCT and immunosuppressive therapy, PTLD should be taken into consideration. 18F-FDG PET/CT may provide additional evidence for supporting or refuting the suspicion of PTLD, and suggest lesions accessible for biopsy.
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Affiliation(s)
| | | | | | | | - Zhanli Fu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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4
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Pan B, Zhu X. 18F-FDG PET/CT imaging of posttransplant lymphoproliferative disorder following renal transplantation: Three clinical cases. Heliyon 2023; 9:e14746. [PMID: 37012908 PMCID: PMC10066522 DOI: 10.1016/j.heliyon.2023.e14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of kidney transplantation, and whole-body 18F- FDG PET/CT imaging plays a key role in patients with PTLD. This article reports three cases of 18F-FDG PET/CT manifestations of gastric, prostate, and pulmonary lymphomas after kidney transplantation, all of which showed local lesions without involvement of adjacent or distant lymph nodes and lymphoid node organs. All patients were treated with a reduced dose of R-CHOP and were generally in a good condition after discharge. Early diagnosis and reasonable treatment are key factors in achieving a better prognosis in patients with PTLD, and whole-body 18F-FDG PET/CT imaging plays an important role in the diagnosis and monitoring of PTLD.
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Toyama Y, Otani M, Yaoita N, Takanami K, Takase K. 18 F-FDG PET/CT Imaging Post Heart Transplantation Depicts High Accumulation at Sites of Previous Ventricular Assist Device Insertion. Clin Nucl Med 2023; 48:366-369. [PMID: 36735390 PMCID: PMC9988220 DOI: 10.1097/rlu.0000000000004580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/29/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT A 37-year-old man with previous heart transplantation for dilated cardiomyopathy underwent screening for malignancy under posttransplantation immunosuppression. 18 F-FDG PET/CT revealed uptake in 2 peritoneal sites of the pericardium that corresponded to the insertion sites of a left ventricular assist device that was used before transplantation. Additional abnormal uptake in the right axillary artery, aortic arch, and left femoral artery corresponded to the insertion sites for arterial inflow during cardiopulmonary bypass. Knowledge that FDG accumulation may occur at the insertion sites of an extracorporeal-circulation device enables unnecessary tests to be avoided.
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Affiliation(s)
- Yoshitaka Toyama
- From the Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masayuki Otani
- Department of Cardiothoracic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- From the Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- From the Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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6
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Si Z, Lu D, Zhai L, Zheng W, Dong C, Sun C, Wang K, Zhang W, Wei X, Zhang Z, Zhao S, Gao W, Shen Z. The value of 18 F-FDG PET/CT quantitative indexes in the diagnosis of nondestructive posttransplant lymphoproliferative disorders after pediatric liver transplantation. Pediatr Transplant 2023:e14501. [PMID: 36906739 DOI: 10.1111/petr.14501] [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: 10/11/2022] [Revised: 01/09/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Posttransplant lymphoproliferative disease (PTLD) is a serious complication after pediatric liver transplantation (pLT), which may lead to death. 18 F-FDG PET/CT is rarely considered in PTLD after pLT and lacks clear diagnostic guidelines, especially in the differential diagnosis of nondestructive PTLD. The aim of this study was to find a quantifiable 18 F-FDG PET/CT index to identify nondestructive PTLD after pLT. METHODS This retrospective study collected the data of patients who underwent pLT, postoperative lymph node biopsy, and 18 F-FDG PET/CT at Tianjin First Central Hospital from January 2014 to December 2021. Quantitative indexes were established using lymph node morphology and the maximum standardized uptake value (SUVmax). RESULTS A total of 83 patients met the inclusion criteria and were included in this retrospective study. To distinguish between PTLD-negative cases and nondestructive PTLD cases, according to the receiver operating characteristic curve, (the shortest diameter of the lymph node at the biopsy site [SDL]/the longest diameter of the lymph node at the biopsy site [LDL])*(SUVmax at the biopsy site [SUVmaxBio]/SUVmax of the tonsils [SUVmaxTon]) had the maximum area under the curve (0.923; 95% confidence interval: 0.834-1.000), and the cutoff value was 0.264 according to the maximum value of Youden's index. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93.6%, 94.7%, 97.8%, 85.7%, and 93.9%, respectively. CONCLUSIONS (SDL/LDL)*(SUVmaxBio/SUVmaxTon) has good sensitivity, specificity, positive predictive and negative predictive values, and accuracy, and can be used as a good quantitative index for the diagnosis of nondestructive PTLD.
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Affiliation(s)
- Zhuyuan Si
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Dongyan Lu
- Department of Nuclear Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Lili Zhai
- Department of Pathology, Tianjin First Central Hospital, Tianjin, China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Chong Dong
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Chao Sun
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Kai Wang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Wei Zhang
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Xinzhe Wei
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Zhixin Zhang
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Shengqiao Zhao
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Wei Gao
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
| | - Zhongyang Shen
- Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China
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7
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Rodrigues AC, Fernandes S, Bustorff M, Nunes AT, Ferreira I, Tavares I, Rocha A, Carneiro A, Sampaio SN. Spleen-Restricted Posttransplant Lymphoproliferative Disorder in the First Year After Kidney Transplant - A Case Report. Transplant Proc 2022; 54:1624-1626. [PMID: 35487782 DOI: 10.1016/j.transproceed.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) are a feared complication after transplant. They are mostly of B cell origin and are frequently Epstein-Barr virus (EBV)-positive, particularly in early onset PTLD. Later on, non-B and EBV-negative PTLD are increasingly reported. EBV seronegative receptors (particularly when paired with an EBV seropositive donor) together with the net degree of immunosuppression-a concept often difficult to quantify-are the most consistently described risk factors for the development of PTLD. Conversely, its association with a particular immunosuppressive agent or other virus, namely cytomegalovirus (CMV) infection or disease, has been inconsistently reported. We present a challenging case where an EBV negative monomorphic peripheric T-cell lymphoma was diagnosed in the first year after kidney transplant in a patient with a recent history of CMV disease from a resistant strain.
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Affiliation(s)
| | - Sara Fernandes
- Nephrology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Manuela Bustorff
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Teresa Nunes
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Ferreira
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Isabel Tavares
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rocha
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Carneiro
- Hematology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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8
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Boyle S, Tobin JWD, Perram J, Hamad N, Gullapalli V, Barraclough A, Singaraveloo L, Han MH, Blennerhassett R, Nelson N, Johnston AM, Talaulikar D, Karpe K, Bhattacharyya A, Cheah CY, Subramoniapillai E, Bokhari W, Lee C, Hawkes EA, Jabbour A, Strasser SI, Chadban SJ, Brown C, Mollee P, Hapgood G. Management and Outcomes of Diffuse Large B-cell Lymphoma Post-transplant Lymphoproliferative Disorder in the Era of PET and Rituximab: A Multicenter Study From the Australasian Lymphoma Alliance. Hemasphere 2021; 5:e648. [PMID: 34651103 PMCID: PMC8505336 DOI: 10.1097/hs9.0000000000000648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5-14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
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Affiliation(s)
- Stephen Boyle
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Joshua W. D. Tobin
- University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Jacinta Perram
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Veena Gullapalli
- Department of Haematology, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Allison Barraclough
- Department of Haematology and Olivia Newton John Cancer Research Institute, The Austin Hospital, Melbourne, Victoria, Australia
| | | | - Min-Hi Han
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Richard Blennerhassett
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Niles Nelson
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Anna M. Johnston
- Royal Hobart Hospital, Hobart, Tasmania, Australia
- University of Tasmania, Hobart, Tasmania, Australia
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Krishna Karpe
- Department of Renal Medicine, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Abir Bhattacharyya
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | | | - Waqas Bokhari
- Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Eliza A. Hawkes
- Department of Haematology and Olivia Newton John Cancer Research Institute, The Austin Hospital, Melbourne, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Jabbour
- Department of Cardiology, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Simone I. Strasser
- University of Sydney, Sydney, New South Wales, Australia
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven J. Chadban
- University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Christina Brown
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
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9
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Post-transplantation lymphoproliferative disorder after haematopoietic stem cell transplantation. Ann Hematol 2021; 100:865-878. [PMID: 33547921 DOI: 10.1007/s00277-021-04433-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a severe complication of haematopoietic stem cell transplantation (HSCT), occurring in a setting of immune suppression and dysregulation. The disease is in most cases driven by the reactivation of the Epstein-Barr virus (EBV), which induces B cell proliferation through different pathomechanisms. Beyond EBV, many factors, variably dependent on HSCT-related immunosuppression, contribute to the disease development. PTLDs share several features with primary lymphomas, though clinical manifestations may be different, frequently depending on extranodal involvement. According to the WHO classification, histologic examination is required for diagnosis, allowing also to distinguish among PTLD subtypes. However, in cases of severe and abrupt presentation, a diagnosis based on a combination of imaging studies and EBV-load determination is accepted. Therapies include prophylactic and pre-emptive interventions, aimed at eradicating EBV proliferation before symptoms onset, and targeted treatments. Among them, rituximab has emerged as first-line option, possibly combined with a reduction of immunosuppression, while EBV-specific cytotoxic T lymphocytes are effective and safe alternatives. Though prognosis remains poor, survival has markedly improved following the adoption of the aforementioned treatments. The validation of innovative, combined approaches is the future challenge.
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Montes de Jesus F, Vergote V, Noordzij W, Dierickx D, Dierckx R, Diepstra A, Tousseyn T, Gheysens O, Kwee T, Deroose C, Glaudemans A. Semi-Quantitative Characterization of Post-Transplant Lymphoproliferative Disorder Morphological Subtypes with [ 18F]FDG PET/CT. J Clin Med 2021; 10:jcm10020361. [PMID: 33477971 PMCID: PMC7835947 DOI: 10.3390/jcm10020361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation classified according to the WHO as nondestructive, polymorphic, monomorphic, and classic Hodgkin Lymphoma subtypes. In this retrospective study, we investigated the potential of semi-quantitative 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/computed tomography (CT)-based parameters to differentiate between the PTLD morphological subtypes. Methods: 96 patients with histopathologically confirmed PTLD and baseline [18F]FDG PET/CT between 2009 and 2019 were included. Extracted semi-quantitative measurements included: Maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean). Results: Median SUVs were highest for monomorphic PTLD followed by polymorphic and nondestructive subtypes. The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD (17.8, interquartile range (IQR):16) than in polymorphic subtypes (9.8, IQR:13.4) and nondestructive (4.1, IQR:6.1) (p = 0.04 and p ≤ 0.01, respectively). An SUVpeak ≥ 24.8 was always indicative of a monomorphic PTLD in our dataset. Nevertheless, there was a considerable overlap in SUV across the different morphologies. Conclusion: The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD than polymorphic and nondestructive subtypes. However, due to significant SUV overlap across the different subtypes, these values may only serve as an indication of PTLD morphology, and SUV-based parameters cannot replace histopathological classification.
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Affiliation(s)
- Filipe Montes de Jesus
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (W.N.); (R.D.); (A.G.)
- Correspondence:
| | - Vibeke Vergote
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium; (V.V.); (D.D.)
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (W.N.); (R.D.); (A.G.)
| | - Daan Dierickx
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium; (V.V.); (D.D.)
| | - Rudi Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (W.N.); (R.D.); (A.G.)
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Thomas Tousseyn
- Department of Pathology University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Thomas Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Christophe Deroose
- Department of Nuclear Medicine, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Andor Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (W.N.); (R.D.); (A.G.)
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11
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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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