Malignant Lymphoma in a Renal Transplant Patient on Cyclosporin a Therapy

Abstract

Cyclosporin A has been associated with an apparent increased incidence of non Hodgkins lymphoma, most often in conjunction with multiple immunosuppressive agents. We report a patient who developed a non Hodgkins lymphoma arising in the right tonsillar fossa six months following renal transplantation. The development of the lymphoma was associated with seroconversion for the Epstein Barr capsid antigen and nuclear antigen. The patient was receiving cyclosporin A alone as immunosuppression.

The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

“…However, the use of cyclosporin A necessitates regular monitoring of blood levels and renal function because of its potential nephrotoxicity, and renal biopsy should be considered after 2 or 3 years of cyclosporin A therapy, even if serum creatinine is normal, since previous studies have shown a lack of correlation between structural damage and renal function [9,29]. Moreover, prolonged therapy with cyclosporin A may be associated with a long-term risk of lymphoma [30,31], and thus such therapy should be considered only in selected patients with SSNS whose disease is difficult to control.…”

Primary central nervous system lymphoma

“…The role of Epstein-Barr virus remains uncertain in the genesis of post-transplant primary central nervous system lymphoma, although at least one case of post-transplant systemic lymphoma was associated with seroconversion for the Epstein-Barr virus capsid antigen and nuclear antigen (Walker et al 1989). As the Epstein-Barr virus appears to have an established role in the pathogenesis of AR-PCNSL, it would be surprising if the mechanisms were any different for cases of PCNSL arising from other immunodeficient states such as organ transplantation.…”

Efficacy of Levamisole as a single agent in maintaining remission in steroid dependant nephrotic syndrome

“…Bone marrow suppression with neutropenia, lymphopenia and thrombocytopenia, alopecia, nausea, abdominal pain and discomfort and haemorrhagic cystitis constitute the shortterm side effects of cyclophosphamide while long-term side effects include increased risk of future malignancy and potential gonadal 6 toxicity . In the mid 1980's immunomodulatory drug LEV and calcineurin inhibitor cyclosporine A were added to the armamentarium of therapies with variable success rate and side effects.While the incidence of reported side effects with LEV is low, the side effects profile of cyclosporine i s s u b s t a n t i a l i n c l u d i n g a r t e r i a l hypertension, hypertrichosis, gingival h y p e r p l a s i a , h y p o m a g n e s a e m i a , hyperuricaemia and potential nephrotoxicity where the histological changes may be indistinguishable from focal segmental 7,8,9 glomerulosclerosis .…”