Post-Transplant Lymphoproliferative Disease (PTLD): Risk Factors, Diagnosis, and Current Treatment Strategies

Al‐Mansour, Zeina; Nelson, Beverly P.; Evens, Andrew M.

doi:10.1007/s11899-013-0162-5

Cited by 267 publications

(306 citation statements)

References 94 publications

(146 reference statements)

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“…Known CD20-negative variants of DLBCL include primary effusion lymphoma, plasmablastic lymphoma, anaplastic lymphoma kinasepositive DLBCL and large B-cell lymphoma arising in human herpes virus 8-associated multicentric Castleman disease [2,3]. Weak or negative CD20 levels have a significant negative impact on the survival of patients with DLBCL [4,5]. PEL, PBL and anaplastic lymphoma kinase-positive DLBCL are variably positive for CD30 [2].…”

Section: Discussionmentioning

confidence: 99%

Diffuse Large B-Cell Lymphoma Trans-differentiating into CD30 Positive Anaplastic Large Cell-like Lymphoma

Bains¹

2017

Ann Hematol Oncol

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Post-Transplant Lymphoproliferative Disorders (PTLD) is mostly of B-cell origin. "Composite" PTLD with diffuse large B-cell lymphoma (DLBCL) and T/ anaplastic large cell lymphoma component are extremely rare. We report a case of PTLD after heart transplant with two distinct components. The patient was initially diagnosed with monomorphic PTLD/DLBCL, EBV negative involving the intestinal wall, occurring nine years after heart transplantation. Sixteen years post-transplant, the lymphoma recurred involving the intestine and showed two distinct components: DLBCL and anaplastic large cell lymphoma with strong homogeneous expression of CD45 and CD30 while lacking B-and T-cell lineage markers mimicking Anaplastic Large Cell Lymphoma (ALCL), ALK negative with a null-cell phenotype and TIA-1 expression. At this time, diffuse lymphadenopathy was also present and a jugular lymph node biopsy prior to the intestinal resection, purely demonstrated only the anaplastic large lymphoma cells with a null-cell phenotype leading to the diagnosis of ALCL, ALK negative. However, molecular studies performed on the anaplastic large cell component identified strongly positive clonal IgH gene rearrangement, identical to the prior lymphoma. Extensive sampling from the intestinal resection specimen identified a transitioning phase between two morphologically and immunohistochemically separate components. This is a unique case of PTLD which demonstrates an immunophenotypic lineage plasticity of the neoplastic cells over an extended post-transplant period.

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Section: Discussionmentioning

confidence: 99%

Diffuse Large B-Cell Lymphoma Trans-differentiating into CD30 Positive Anaplastic Large Cell-like Lymphoma

Bains¹

2017

Ann Hematol Oncol

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“…Epstein-Barr virus-transformed B cells can proliferate without T-cell control in the face of immunosuppressive treatment after transplant. 4 Other infections, such as cytomegalovirus and hepatitis, have also been shown to increase the risk of PTLD. Further risk factors include treatment for acute rejection and heavy immuno suppressive burden, age, race, and genetic factors.…”

Section: Discussionmentioning

confidence: 99%

“…Further risk factors include treatment for acute rejection and heavy immuno suppressive burden, age, race, and genetic factors. 4 The disease can affect the allograft and often can be extranodal involving the central nervous system, the gastrointestinal tract, and bone marrow; therefore, the clinical presentation of PTLD can vary depending on the organ affected. Lymphadenopathy is not always present but development of classic "B" sym ptoms should carry a high index of suspicion.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

Exp Clin Transplant

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Posttransplant lymphoproliferative disease is a complication of organ transplant with a myriad clinical and anatomic manifestations, thus making diagnosis difficult without histologic confirmation. In cases of lymphadenopathy confined to the abdomen, the diagnosis can be delayed because of late presentation and difficulty obtaining a tissue for histologic analyses.We describe the use of cross-sectional nuclear medicine imaging to locate enlarged abdominal lymph nodes; this facilitated minimally invasive laparoscopic lymph node excision biopsy to rapidly diagnose 2 cases of post -transplant lympho proliferative disease. Prompt diagnosis has enabled early effective treatment, resulting in good patient outcomes.

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“…Therefore, the authors concluded that the present case was EBV non-associated lymphoma. In cases of EBV-related PTLD, the reduction of immunosuppression has been a mainstay of PTLD treatment (19). Rituximab, which is an anti-CD20 monoclonal antibody, is strongly suggested in a systemic disease (20).…”

Section: Case Reportmentioning

confidence: 99%

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

Chang

Yang

et al. 2018

Korean J Transplant

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Lymphoproliferative disorder in a posttransplant setting has emerged as a difficult problem in kidney transplantation (KT).Lymphoma involving adnexa of the eye has rarely been reported due to scarcity of lymphoreticular tissue in the ocular area. This report presents a case of a 37-year-old KT recipient who was diagnosed with conjunctival mucosa-associated lymphoid tissue lymphoma with a chief complaint of seeing black spots. Unlike other post-transplant lymphoproliferative diseases associated with the Epstein-Barr virus (EBV) reactivation via immunosuppression, the lesion was not related to the virus. The patient received radiotherapy with concomitant conversion from the tacrolimus to the sirolimus. Overall, the results presented herein indicate lymphoma may be an important differential diagnosis when KT recipients complain of ocular discomfort. Case Report INTRODUCTIONKidney transplantation (KT) is an emerging option for renal replacement therapy that improves the quality of life, as compared to dialysis. However, immunosuppressive therapy for the prevention of rejection can lead to lymphoproliferative disease after KT up to 1% to 20%(1). The extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type that belonged to the indolent B-cell lymphomas which is mainly an observed gastric mucosa and it is associated with the Helicobacter pylori infection(2-5), has been rarely reported as originating from other sites. We herein report a case of a KT recipient who is diagnosed with extranodal marginal zone lymphoma involving both conjunctivae. CASE REPORTA 37-year-old woman with end-stage renal disease due to lupus nephritis received a living-donor KT after 5 years of peritoneal dialysis. The donor was her mother, and the human leukocyte antigen mismatch number was 2. She underwent induction therapy by using basiliximab, and thereafter maintained immunosuppression with tacrolimus, mycophenolic acid, and deflazacort. The trough level of tacrolimus has been maintained between 4∼5 ng/mL. The allograft function was kept stable with an estimated glomerular filtration rate of 60 mL/min/1.73 m Cytomegalovirus and Epstein-Barr virus (EBV) were not detected in the real-time polymerase chain reaction test. In the ophthalmic examination, multiple cystic nodules located in both lower conjunctivae were found. The cystic nodules were biopsied and diagnosed with extranodal marginal zone lymphoma of MALT type (Fig. 1). During the staging workup for lymphoma, orbital magnetic resonance imaging and positron emission tomography computed tomography (PET-CT) showed hypertrophic changes in the lower conjunctivae of both eyes and tonsils (Fig. 2). The bone marrow finding was normal, and the chromosome analysis of hematology/oncology showed no atypical clone. The stain for EBV was negative. The patient also underwent esophagogastroduodenoscopy with a negative result of H. pylori It is generally known that MALT lymphoma most frequently develops in the stomach due to the H. pylori infection(12). Only rare nongastric MA...

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Post-Transplant Lymphoproliferative Disease (PTLD): Risk Factors, Diagnosis, and Current Treatment Strategies

Cited by 267 publications

References 94 publications

Diffuse Large B-Cell Lymphoma Trans-differentiating into CD30 Positive Anaplastic Large Cell-like Lymphoma

Diffuse Large B-Cell Lymphoma Trans-differentiating into CD30 Positive Anaplastic Large Cell-like Lymphoma

Untitled

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

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