Posttransplant lymphoproliferative disease: treatment and outcome in renal transplant recipients

Soler, María José; Puig, Josep; Mir, Marisa; Parrilla, Juan Sanchez; Pedro, Carmen; Salar, Antonio; Serrano, Sergio; Lloveras, J

doi:10.1016/s0041-1345(03)00667-5

Cited by 30 publications

(30 citation statements)

References 16 publications

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“…These appear higher than rates reported for transplant patients without MGUS [23,24]. At our institution, only 57 (1.6%) of the 3,476 KTx patients developed PTLD, which is in line with the rates reported in the literature (0.7–2.0%) [23,24,25]. The reasons for the higher rate of PTLD remain unclear, and our data should be interpreted with caution.…”

Section: Discussionsupporting

confidence: 87%

Long-Term Follow-Up of Patients with Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation

Naina¹,

Harris

Dispenzieri

et al. 2012

Am J Nephrol

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Introduction: Long-term data regarding kidney transplantation (KTx) patients with monoclonal gammopathy of undetermined significance (MGUS) are scarce. We evaluated the long-term outcomes of these patients in a single-center retrospective study from the Mayo Clinic, Rochester, Minn., USA. Methods: Patients who had an MGUS before transplant or developed one after KTx were selected. Monoclonal protein was screened as part of the KTx evaluation by serum protein electrophoresis. Screening for posttransplant lymphoproliferative disorder (PTLD) or MGUS after transplant was not required by protocol. Patients with multiple myeloma, dysproteinemia-related kidney disease or no pretransplant serum protein electrophoresis were excluded. Results: Between 1963 and 2006, 3,518 patients underwent KTx. MGUS was identified in 42 patients, with 23 before transplant and 19 after transplant. Median follow-up for these patients was 8.5 years (range 0.3–37). Four (17.4%) pretransplant MGUS patients developed a hematologic malignancy: 2 smoldering multiple myeloma and 2 PTLD – an Epstein-Barr virus-positive diffuse large cell lymphoma and a Hodgkin lymphoma. None of the 19 patients who developed an MGUS after transplant progressed to multiple myeloma, but 2 (10.5%) developed Epstein-Barr virus-negative T cell lymphoproliferative disorders at 16 and 26 years after transplant. Median survival was 26.1 and 28.0 years for the pretransplant and posttransplant MGUS groups, respectively. Conclusion: Progression from true MGUS to multiple myeloma is rare after KTx. KTx appears safe in true MGUS patients if the monoclonal gammopathy was not the cause of the kidney disease. None of the patients progressed to multiple myeloma, but 2 developed smoldering multiple myeloma and several developed PTLD. Further studies are needed to explain the relationship between MGUS and PTLD.

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Section: Discussionsupporting

confidence: 87%

Long-Term Follow-Up of Patients with Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation

Naina¹,

Harris

Dispenzieri

et al. 2012

Am J Nephrol

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“…The majority (approximately 70%) of PTLD cases following renal transplantation result as a consequence of reactivation infection with EBV, a DNA virus that survives immortally within Blymphocytes [74]. Rapid replication of EBV-laden B-lymphocytes may occur in the setting of cytotoxic T-lymphocyte dysfunction induced by immunosuppressive therapy [76]. Cytotoxic T-lymphocytes normally prevent proliferation of EBV-infected B-lymphocytes.…”

Section: Pancytopenia Related To Post-transplant Hematopoietic Malignmentioning

confidence: 99%

“…Additionally, immunostains of PTLD tissue are usually positive for EBV latent membrane protein (LMP) and Epstein-Barr encoded RNA (EBER), reflecting integration of EBV within the B-lymphocyte population [75]. Cases occurring in the first few weeks to months following renal transplantation are often of the polymorphic type, while cases occurring after the first year are most often monomorphic in nature and behave aggressively [76]. Lymphatic involvement by PTLD is often extranodal with protean organ involvement; patients with overt NHL often present with stage III or IV disease [80].…”

Section: Pancytopenia Related To Post-transplant Hematopoietic Malignmentioning

confidence: 99%

“…Lymphatic involvement by PTLD is often extranodal with protean organ involvement; patients with overt NHL often present with stage III or IV disease [80]. Anatomic sites of involvement most commonly include lymph nodes and the gastrointestinal tract, although the lung parenchyma, brain, spleen, omentum, parotid glands, the renal allograft, postoperative lymphocele, and bone marrow are occasionally involved [75][76][77][78][79][80][81][82].…”

Section: Pancytopenia Related To Post-transplant Hematopoietic Malignmentioning

confidence: 99%

“…Common symptoms of PTLD in the renal transplant population include acute-onset fever, night sweats, weight loss, abdominal pain, and anorexia; however, fecal bleeding or cough can occur with gastrointestinal tract or pulmonary involvement, respectively [74][75][76]80]. Physical examination may reveal tonsillar enlargement, parotid hypertrophy, lymphadenopathy, hepatosplenomegaly, or pulmonary rates [76].…”

Section: Pancytopenia Related To Post-transplant Hematopoietic Malignmentioning

confidence: 99%

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Hematologic abnormalities following renal transplantation

Marinella

2009

Int Urol Nephrol

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Recipients of renal allografts are surviving longer and, consequently, may experience a variety of complications related not only to the transplanted kidney, but also to the hematopoietic system. Common hematologic complications in the renal transplant patient include abnormalities of one cell line, such as post-transplantation erythrocytosis or anemia, that are often treatable with simple measures. Conversely, pathologies involving the leukocyte and platelet population often exist in the context of pancytopenia, which may be a manifestation of systemic infection (e.g., cytomegalovirus, human herpesvirus 8) or malignancy (post-transplantation lymphoproliferative disorders). Uncommon, but life-threatening, processes complicating renal transplantation include hepatosplenic gammadelta T-cell lymphoma and viral-induced hemophagocytic syndrome, both of which are associated with severe pancytopenia and, often, death. Since this patient population is often managed in a multidisciplinary fashion by nephrologists, infection specialists, transplant surgeons, hematologists, and internal medicine physicians, a succinct review of this topic is warranted.

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