Characterization of primary cutaneous T‐cell lymphoma following solid organ transplantation

Abstract

Background Immunosuppression following solid organ transplantation is a known risk factor for the development of posttransplant lymphoproliferative disorders (PTLD). Primary cutaneous T‐cell lymphoma (CTCL) occurring in the posttransplant setting is rare, which has made comprehensive understanding of this disease challenging. This study aims to further characterize the spectrum of clinicopathologic features of CTCL in solid organ transplant recipients (SOTR). Methods A retrospective chart review was performed for SOTR who were diagnosed with CTCL at a multi‐site academic medical center from January 1, 1998, to December 31, 2013. Eight patients fulfilled the inclusion criteria and were included in this study. Data collected included patient demographics, transplanted organ, the time between transplant and CTCL diagnosis, clinical presentation and rash morphology, a histological subtype of CTCL, immunosuppression regimens, and patient status. Twelve diagnostic skin biopsies for five patients were examined and reviewed by a board‐certified dermatopathologist. Results Six (75%) out of the eight patients were men, two (25%) were women, and the median age was 53 years. The median time from the date of transplant to the diagnosis of CTCL was 8.2 years. Transplanted organs included the liver (4), kidney (3), and heart (1). Clinical presentation varied from papulonodules, comedone‐like lesions, intense pruritis, and scaly erythematous eruptions. The most common histologic presentation was folliculotropic mycosis fungoides (FMF) (7/12). Epstein–Barr virus‐in situ hybridization (EBV‐ISH) was negative in all specimens. Conclusions We emphasize the rarity of CTCL among SOTR. Although rare in the general population, the FMF subtype appears to be disproportionately seen in SOTR compared with other CTCL.

Mycosis Fungoides in Solid-Organ Transplant Recipients: A Multicenter Retrospective Cohort Study

“…Similar to MF in immunocompetent population [31], general male predominance was noted in the previous reports of SOTR MF patients (74%) and in the present cohort (70%). Of the previously reported cases, 56% were post renal transplantation, compared to 40% in the current study, where 50% were post liver transplantation, with only 5 such cases reported in the literature [20,21]. Although this finding may only reflect the increased transplantation rate of other organs than the kidney with time [32], the nature of the transplanted organ and the different immunosuppression protocols can also have its contribution.…”

“…MF among SOTRs is rarely described, with approximately 34 cases reported since 1992 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. An incidence rate of 1.903 patients with MF per 1,000 SOTRs was observed in the present study, which is [24,25].…”

“…Although this finding may only reflect the increased transplantation rate of other organs than the kidney with time [32], the nature of the transplanted organ and the different immunosuppression protocols can also have its contribution. The median interval between first transplantation and the diagnosis of MF according to the literature was 6 years [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], compared to 8 years in the present study. In previous reports, all but 1 were adult patients [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…The reported cases of MF/SS in SOTRs had heterogeneous characteristics and course of disease, and the approach toward alterations of the immunosuppression in the setup of lymphoma, given to prevent organ rejection, was not uniform [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. In the present study, the characteristics, management, and course of MF in SOTRs are presented, with a specific focus on the therapeutic approach for MF, and on the management of the immunosuppressive treatments given to these patients.…”

Folliculotropic Mycosis Fungoides: Current Guidance and Experience from Clinical Practice

“…As for special populations, the FMF subtype has been recently found to be over-represented in solid organ transplant recipients and in paediatric patients, compared with other CTCL variants. 6 , 7 Recent studies reported 10-year survival rates of 72% in skin-limited early stages, 28% in skin-limited advanced stages, and 2% in FMF with extracutaneous localizations at first presentation. 5 As for therapeutic options, the latest guidelines on MF agree on a stage-driven strategy, in consideration of clinical presentation, symptom burden and patient’s comorbidities.…”