Diffuse large B-cell lymphoma arising from donor lymphoid cells after renal and pancreatic transplantation

Abstract

A patient with both a renal and pancreatic transplantation developed a diffuse large B-cell lymphoma, Epstein-Barr virus-related, 14 months after the surgical procedure. Tumor was confined to the transplanted organs: head of the pancreas and hilar lymph node of the transplanted kidney. Chimerism analysis demonstrated the tumor origin from donor lymphoid cells. Immunosuppression was discontinued and chemotherapy with cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone (CHOP) was started. However, no response was observed after three courses of this regimen. Finally, a transplantectomy was carried out, followed by rituximab (anti-CD20 antibody), with the patient achieving a complete response (CR). Two years later the patient remains in CR.

Epstein-Barr Virus-Associated Posttransplant Lymphoproliferative Disorder of Donor Origin after Simultaneous Pancreas–Kidney Transplantation Limited to Pancreas Allograft: A Case Report

“…He received CHOP without success, similar to our patient the allografts were removed, rituximab was administered in the described case after transplantectomy and the patient also remained in complete remission (14). There is one further case report about a SPKT patient with lymphoma of donor origin in both kidney and pancreas allografts, who in contrast to our patient presented without symptoms and was diagnosed by routine ultrasound examination.…”

“…However, in SPKT as shown in our patient and the case described by Cibeira et al (14), explantation of the allografted organs after chemotherapy is a curative treatment option. As the origin of the lymphoma influences prognosis and further therapy in addition to histopathological evaluation microsatellite analysis should be performed.…”

“…Prognosis and response to therapy (reduction of immunosuppression and rituximab treatment) has been described as more favorable in donor-derived compared with host-derived PTLD after kidney transplantation. However, in SPKT as shown in our patient and the case described by Cibeira et al (14), explantation of the allografted organs after chemotherapy is a curative treatment option. If conventional PTLD therapy is without effect in donorderived lymphoma after single kidney or SPKT, removal of the allografts, should be considered.…”

“…There is one further case report about a SPKT patient with lymphoma of donor origin in both kidney and pancreas allografts, who in contrast to our patient presented without symptoms and was diagnosed by routine ultrasound examination. He received CHOP without success, similar to our patient the allografts were removed, rituximab was administered in the described case after transplantectomy and the patient also remained in complete remission (14).…”

Post-transplant Lymphoproliferative Disorders: Determination of Donor/Recipient Origin in a Large Cohort of Kidney Recipients

“…From the histological point of view, a spectrum of lesions ranging from infectious mononucleosis to a malignant lymphoma comprises the clinical entity known as PTLD (9). A number of small‐scale studies and case reports have shown that PTLDs localized in the graft organ itself may originate from donor cells without being donor transmitted (10–31). Nevertheless, contrary to bone marrow transplant where PTLDs typically derive from donor lymphocytes, the majority of PTLDs that develop after organ transplantation derive from recipient lymphocytes (32–34).…”