Post‐transplant lymphoproliferative disorder presenting as multiple myeloma

Ninan, Mary J.; Datta, Yvonne H.

doi:10.1002/ajh.21762

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…The two patients with plasmacytomas had EBV replication in blood, with evidence of EBV replication in situ in one of them, and published data strongly suggest a link between plasmacytoma and EBV infection [8,14–16,18,19,21,24,38,39]. The role of EBV in onset of myeloma is less clear, and this also suggests that plasmacytoma and myeloma may have different courses of pathophysiological development.…”

Section: Discussionmentioning

confidence: 99%

Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature

et al. 2017

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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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Section: Discussionmentioning

confidence: 99%

Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature

et al. 2017

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“…23,24 Prior studies have shown an increased risk of multiple myeloma in HIV-infected individuals and immunosuppressed transplant recipients. 3 Case reports describe detection of EBV in tumor cells from immunosuppressed multiple myeloma cases, 25 and 1 case-control study found an association with hepatitis B virus. 26 However, other studies have shown no associations with these viruses.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of histologically defined cancer subtypes in human immunodeficiency virus–infected individuals

Shiels¹,

Engels²

2012

Cancer

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Background Malignancies that occur in excess among HIV-infected individuals may be caused by immunosuppression or infections. Because histologically-defined cancer subtypes have not been systematically evaluated, we assessed their risk among people with AIDS. Methods Analyses included 569,268 people with AIDS from the HIV/AIDS Cancer Match Study, a linkage of 15 U.S. population-based HIV/AIDS and cancer registries during 1980–2007. Standardized incidence ratios (SIRs) were estimated to compare cancer risk in people with AIDS to the general population overall, and stratified by age, calendar period (a proxy of changing HIV therapies) and time since AIDS (a proxy of immunosuppression). Results Sixteen individual cancer histologies or histology groupings manifested significantly elevated SIRs. Risks were most elevated for adult T-cell leukemia/lymphoma (SIR=11.3), neoplasms of histiocytes and accessory lymphoid cells (SIR=10.7), giant cell carcinoma (SIR=7.51) and leukemia not otherwise specified (NOS) (SIR=6.69). SIRs ranged from 1.4 to 4.6 for spindle cell carcinoma, bronchioloalveolar adenocarcinoma, adnexal and skin appendage neoplasms, sarcoma NOS, spindle cell sarcoma, leiomyosarcoma, mesothelioma, germ cell tumors, plasma cell tumors, immunoproliferative diseases, acute lymphocytic leukemia and myeloid leukemias. For several of these cancer subtypes, we observed significant declines in SIRs across calendar periods (consistent with decreasing risk with improved HIV therapies) or increase in SIRs with time since AIDS (i.e., prolonged immunosuppression). Conclusions The elevated risk of certain cancer subtypes in people with AIDS may point to an etiologic role of immunosuppression or infection. Future studies are needed to further investigate these associations and evaluate candidate infectious agents.

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“…Most of the cases are associated with Epstein‐Barr virus (EBV). Among monomorphic PTLD, plasma‐cell myeloma (PCM) and plasmacytoma‐like lesion (PLL) are rare (less than 5% of PTLD) with less than 60 cases reported in the literature (Melato and Paladini, ; Schemankewitz et al, ; Chucrallah et al, ; Joseph et al ; Fischer et al, ; Harris et al, ; Leigh et al, ; Ibe et al, ; Papadaki et al, ; Au et al, ; Pacheco et al, ; Gupta et al, ; Sun et al, ; Syed et al, ; Takahashi et al, ; Komrokji et al, ; Tcheng et al, ; Willoughby et al, ; McFarlane et al, ; Richendollar et al, ; Ninan and Datta, ; Trappe et al, ; Molina‐Ruiz et al, ; Karuturi et al, ; Kuppachi et al, ; Perry et al, ; Plant et al, ), the largest series including 9 patients (Karuturi et al, ). Currently, reduction of immunosuppressive therapy (RIT) is commonly performed when PTLD is diagnosed with, however, a low response rate and a high risk of rejection.…”

Section: Introductionmentioning

confidence: 99%

Array‐CGH predicts prognosis in plasma cell post‐transplantation lymphoproliferative disorders

Sarkozy

Kaltenbach

Faurie

et al. 2016

Genes Chromosomes & Cancer

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Plasma-cell post-transplantation lymphoproliferative disorder (PC-PTLD) is a rare monomorphic PTLD entity divided into plasma cell myeloma (PCM) and plasmacytoma-like lesion (PLL) PTLD. To date, there are no exhaustive published cytogenetic data on PC-PTLD. We report array-based comparative genomic hybridization (aCGH) of 10 cases of PCM and PLL-PTLD. Patients had received kidney (n = 6), heart (n = 2), lung (n = 1) or bone marrow (n = 1) transplantation. There were six men and median age at time of PTLD was 56.5 years (3-74). We identified two different cytological features, plasmacytic and plasmablastic, among six PLL and three PCM PTLD. Eight cases were associated with EBV. First line treatment was heterogeneous: rituximab alone (n = 5), CHOP-like (n = 3) and multiple myeloma-like (n = 1). One patient died before any treatment. After a median follow-up of 19.5 months (0-150), five patients died (four from PTLD) and five were alive without evidence of disease. By aCGH, 5/10 demonstrated a complex profile. The most frequent abnormalities were +7q (5/10), +16q (5/10), +17q (5/10), +17p (4/10), +5q (4/10), t7 (4/10), t9 (3/10), del1p (3/10). No del17p13 (TP53) were observed. Del1p32.3 (CDKN2C) was observed in 2 cases. On univariate prognostic analysis, a complex aCGH was associated with a shorter OS. Thus, cytogenetic abnormalities seem to be closely related to those reported in multiple myeloma or diffuse large B cell lymphoma. Complex aCGH constitutes an unfavorable prognostic marker and aCGH should be integrated in the evaluation of patients with PLL/PCM-PTLD. © 2016 Wiley Periodicals, Inc.

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Post‐transplant lymphoproliferative disorder presenting as multiple myeloma

Cited by 7 publications

References 21 publications

Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature

Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature

Increased risk of histologically defined cancer subtypes in human immunodeficiency virus–infected individuals

Array‐CGH predicts prognosis in plasma cell post‐transplantation lymphoproliferative disorders

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