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Plasmacytoma-like post-kidney-transplant lymphoproliferative disorder confined to renal allograft and urinary tract: A case report. Nephrol Ther 2018; 14:544-547. [PMID: 30301610 DOI: 10.1016/j.nephro.2018.07.404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 11/21/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a well-know complication after organ transplantation. We report a case of a patient who developed an extramedullary plasmacytoma-like PTLD around his transplanted kidney treated with standard multiple myeloma chemotherapy. Three years after benefiting of a deceased donor kidney transplant for an end stage kidney disease secondary to nephroangiosclerosis, our patient developed an extra-medullary plasmacytoma confined to the transplant compartment. The transplant function was unaltered, and due to the absence of reduction of the lesion after immunosuppression reduction, a chemotherapy by bortezomib-cyclophosphamide-dexamethasone (VCD) known to be efficient in multiple myeloma was initiated. After 6 cycles, positron emission tomography (PET) scan showed complete metabolic remission confirming the biological exams. This case report suggests that a chemotherapy such as VCD can efficiently treat plasmacytoma-like PTLD allowing graft survival. Therefore, transplant removal may not be mandatory as the best second line treatment after unsuccessfulness reduction of immunosuppression.
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Kormann R, François H, Moles T, Dantal J, Kamar N, Moreau K, Bachelet T, Heng AE, Garstka A, Colosio C, Ducloux D, Sayegh J, Savenkoff B, Viglietti D, Sberro R, Rondeau E, Peltier J. Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature. PLoS One 2017; 12:e0179406. [PMID: 28636627 PMCID: PMC5479561 DOI: 10.1371/journal.pone.0179406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/30/2017] [Indexed: 12/30/2022] Open
Abstract
Although post-transplant lymphoproliferative disorder (PTLD) is the second most common type of cancer in kidney transplantation (KT), plasma cell neoplasia (PCN) occurs only rarely after KT, and little is known about its characteristics and evolution. We included twenty-two cases of post-transplant PCN occurring between 1991 and 2013. These included 12 symptomatic multiple myeloma, eight indolent myeloma and two plasmacytomas. The median age at diagnosis was 56.5 years and the median onset after transplantation was 66.7 months (2-252). Four of the eight indolent myelomas evolved into symptomatic myeloma after a median time of 33 months (6-72). PCN-related kidney graft dysfunction was observed in nine patients, including six cast nephropathies, two light chain deposition disease and one amyloidosis. Serum creatinine was higher at the time of PCN diagnosis than before, increasing from 135.7 (±71.6) to 195.9 (±123.7) μmol/l (p = 0.008). Following transplantation, the annual rate of bacterial infections was significantly higher after the diagnosis of PCN, increasing from 0.16 (±0.37) to 1.09 (±1.30) (p = 0.0005). No difference was found regarding viral infections before and after PCN. Acute rejection risk was decreased after the diagnosis of PCN (36% before versus 0% after, p = 0.004), suggesting a decreased allogeneic response. Thirteen patients (59%) died, including twelve directly related to the hematologic disease. Median graft and patient survival was 31.7 and 49.4 months, respectively. PCN after KT occurs in younger patients compared to the general population, shares the same clinical characteristics, but is associated with frequent bacterial infections and relapses of the hematologic disease that severely impact the survival of grafts and patients.
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Affiliation(s)
- Raphaël Kormann
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Pierre et Marie Curie, Paris, France
| | - Hélène François
- Service de Néphrologie, Hôpital Bicêtre, APHP, Université Paris Sud, Paris, France
| | - Thibault Moles
- Service de Néphrologie et d'Immunologie Clinique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Jacques Dantal
- Service de Néphrologie et d'Immunologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Nassim Kamar
- Service de Néphrologie et Transplantation, CHU Rangueil, Toulouse, Toulouse, France
| | - Karine Moreau
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Thomas Bachelet
- Centre de Traitement des Maladies Rénales-Clinique Saint Augustin, 96 avenue d’Arès, Bordeaux, France
| | - Anne-Elisabeth Heng
- Service de Néphrologie—Hémodialyses, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Antoine Garstka
- Service de Néphrologie, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Charlotte Colosio
- Service de Néphrologie—Hypertension artérielle—Hémodialyse—Transplantation, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Didier Ducloux
- Service de Néphrologie-Dialyse, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France
| | - Johnny Sayegh
- Service de Néphrologie—Dialyse—Transplantation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Benjamin Savenkoff
- Service de Néphrologie et Transplantation, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
| | - Denis Viglietti
- Service de Néphrologie, Hôpital Saint Louis, Université Denis Diderot-Paris VII AP-HP, Paris, France
| | - Rebecca Sberro
- Service de Transplantation, Hôpital Necker, Université Paris Descartes AP-HP, Paris, France
| | - Eric Rondeau
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Pierre et Marie Curie, Paris, France
| | - Julie Peltier
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Pierre et Marie Curie, Paris, France
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Sarkozy C, Kaltenbach S, Faurie P, Canioni D, Berger F, Traverse-Glehen A, Ghesquieres H, Salles G, Bachy E, Alyanakian MA, Hermine O, Neven B, Macintyre E, Romana S, Molina TJ, Suarez F, Asnafi V, Bruneau J. Array-CGH predicts prognosis in plasma cell post-transplantation lymphoproliferative disorders. Genes Chromosomes Cancer 2016; 56:221-230. [DOI: 10.1002/gcc.22428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Clémentine Sarkozy
- Service d'Hématologie; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud; Pierre Bénite cedex 69495 France
- INSERM1052, CNRS 5286; Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1; Pierre Bénite cedex 69495 France
| | - Sophie Kaltenbach
- Laboratoire de cytogénétique, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
| | - Pierre Faurie
- Centre Léon Bérard, service d'Hématologie; Université Claude Bernard Lyon 1; Lyon France
| | - Danielle Canioni
- Service de Pathologie, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
- Institut Necker-Enfants Malades (INEM); Institut national de recherche médicale (INSERM) UMR1151/CNRS8253, Université Paris Descartes Sorbonne Cité; Paris France
| | - Françoise Berger
- Hospices Civils de Lyon; Centre Hospitalier Lyon-Sud, Service de Pathologie; Lyon France
| | | | - Hervé Ghesquieres
- Centre Léon Bérard, service d'Hématologie; Université Claude Bernard Lyon 1; Lyon France
- INSERM1052, CNRS 5286; Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1; Pierre Bénite cedex 69495 France
| | - Gilles Salles
- Service d'Hématologie; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud; Pierre Bénite cedex 69495 France
- INSERM1052, CNRS 5286; Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1; Pierre Bénite cedex 69495 France
| | - Emmanuel Bachy
- Service d'Hématologie; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud; Pierre Bénite cedex 69495 France
- INSERM1052, CNRS 5286; Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1; Pierre Bénite cedex 69495 France
| | - Marie-Alexandra Alyanakian
- Laboratoire d'Immunologie, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
| | - Olivier Hermine
- Service d'Hématologie Adulte, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP); Université Paris Descartes Sorbonne Cité; Paris France
- Inserm U1163/CNRS ERL8254, Institut Imagine (Lab 215-217); Site Hôpital Necker - Enfants Malades; Paris France
| | - Bénédicte Neven
- Service d'Immuno-Hématologie Pédiatrique; Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
| | - Elizabeth Macintyre
- Institut Necker-Enfants Malades (INEM); Institut national de recherche médicale (INSERM) UMR1151/CNRS8253, Université Paris Descartes Sorbonne Cité; Paris France
- Laboratoire d'Onco-Hématologie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Descartes Sorbonne Cité; Paris France
| | - Serge Romana
- Laboratoire de cytogénétique, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
| | - Thierry Jo Molina
- Service de Pathologie, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
| | - Felipe Suarez
- Service d'Hématologie Adulte, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP); Université Paris Descartes Sorbonne Cité; Paris France
- Inserm U1163/CNRS ERL8254, Institut Imagine (Lab 215-217); Site Hôpital Necker - Enfants Malades; Paris France
| | - Vahid Asnafi
- Institut Necker-Enfants Malades (INEM); Institut national de recherche médicale (INSERM) UMR1151/CNRS8253, Université Paris Descartes Sorbonne Cité; Paris France
- Laboratoire d'Onco-Hématologie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Descartes Sorbonne Cité; Paris France
| | - Julie Bruneau
- Service de Pathologie, Hôpital Necker - Enfants Malades; Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes Sorbonne Cité; Paris France
- Inserm U1163/CNRS ERL8254, Institut Imagine (Lab 215-217); Site Hôpital Necker - Enfants Malades; Paris France
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Wang TF, Klein JL, Woodard PK, Hassan A, Joseph SM, Ewald GA, Uy GL. Plasmacytoma-like post-transplantation lymphoproliferative disease occurring in a cardiac allograft: a case report and review of the literature. J Clin Oncol 2012; 30:e278-82. [PMID: 22711849 DOI: 10.1200/jco.2011.39.5855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tzu-Fei Wang
- Washington University School of Medicine, St Louis, MO, USA
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Richendollar BG, Hsi ED, Cook JR. Extramedullary plasmacytoma-like posttransplantation lymphoproliferative disorders: clinical and pathologic features. Am J Clin Pathol 2009; 132:581-8. [PMID: 19762536 DOI: 10.1309/ajcpx70tihetnbrl] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Most monomorphic posttransplantation lymphoproliferative disorders (PTLDs) resemble diffuse large B-cell lymphoma or Burkitt lymphoma. Rare cases of PTLD resembling extramedullary plasmacytomas have also been described. This report describes the clinical, histologic, phenotypic, and genotypic findings in 4 cases of plasmacytoma-like PTLD (2 nodal, 1 adenoidal, and 1 cutaneous) and compares the findings with extramedullary involvement by plasma cell neoplasms arising in immunocompetent patients. Plasmacytoma-like PTLDs characteristically arise late after transplantation (mean, 7.0 years), show a variable association with Epstein-Barr virus (2/4 cases positive), and demonstrate histologic and phenotypic findings that overlap with immunocompetent extramedullary plasma cell neoplasms. None of the patients with plasmacytoma-like PTLD developed lytic bone lesions, and 3 of 4 patients had complete responses (>2 years) to reduction of immunosuppression, confirming the role of immunosuppression in the pathogenesis of these lesions. This report, which represents the first case series of plasmacytoma-like PTLD, clarifies the features of this rare subtype of PTLD.
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Affiliation(s)
| | - Eric D. Hsi
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH
| | - James R. Cook
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH
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