Risk Factors and Prognosis in T-Cell Posttransplantation Lymphoproliferative Diseases

Tiede, Christina; Maecker‐Kolhoff, Britta; Klein, Christoph; Kreipe, Hans; Hussein, Kais

doi:10.1097/tp.0b013e3182762e07

Cited by 50 publications

(56 citation statements)

References 110 publications

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“…11,13,14 Older age, involvement of the central nervous system or bone marrow, and relapse after bone marrow transplantation have been implicated with a worse lymphoma prognosis. 18,19,20 Although their continued relevance in the rituximab/Positron Emission Tomography era has been called into question, 18 the Ann Arbor stage 21 and Age-adjusted International Prognostic Index 22 are tools used to determine lymphoma prognosis. These studies also include age, stage, serum lactate dehydrogenase (LDH) and performance status in their models.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Fu¹,

Lee²,

Smith³

et al. 2013

PM&R

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Objective-To assess the frequency and risk factors for return to the primary acute care service among lymphoma patients undergoing inpatient rehabilitation.Design-Retrospective study. Setting-Tertiary referral-based cancer center.Patients-All patients with a history of lymphoma admitted to inpatient rehabilitation between October 1, 2003 and January 30, 2013.Main Outcome Measures-Items analyzed from patient records included return to the primary acute care service with demographic information, lymphoma characteristics, medications, hospital admission characteristics, and laboratory values.Results-143 unique patient admissions were analyzed. 54/143 (38%) of lymphoma inpatient rehabilitation admissions returned to the primary acute care service. However, 16/54 (30%) returned due to needing additional chemotherapy. Excluding patients who returned to the primary acute care service for chemotherapy, statistically significant or approaching statistically significant factors (p<.10) associated with return to the primary acute care service included a creatinine greater than or equal to 1.3 milligrams/deciliter (mg/dL) (p=0.0002), male sex (p=0.001), history Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclosures: NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of hematopoietic stem cell transplant (p=0.0355), and presence of intravenous antifungal agent (p=0.0717). Of those transferred back to the primary acute care service; 13/38 (34%) discharged directly home, 10/38 (26%) died in the hospital, 7/38 (18%) transferred to a subacute rehabilitation facility, and 4/38 (11%) transferred to inpatient rehabilitation.Conclusions-Chemotherapy was the most common reason for return to the primary acute care service. When excluding patients who returned for chemotherapy, lymphoma patients who are male, who have had a hematopoietic stem cell transplant, and have a creatinine greater than or equal to 1.3 mg/dL demonstrated increased risk for return to the primary acute care service.

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Section: Discussionmentioning

confidence: 99%

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Fu¹,

Lee²,

Smith³

et al. 2013

PM&R

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“…In contrast to B cell PTLD, which usually manifests as DLBCL or Burkitt's lymphoma subtypes, T cell PTLD shows a variety of T cell lymphoma subtypes from relatively benign large granular lymphocytic leukemia (LGL) types to high-grade T cell lymphomas [33]. …”

Section: Monomorphic Ptldmentioning

confidence: 99%

Posttransplant Lymphoproliferative Disorder in Pediatric Patients

Hussein¹,

Tiede²,

Maecker‐Kolhoff³

et al. 2013

Pathobiology

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Transplantation of solid organs and hematopoietic stem cells is accompanied by profound disturbance of immune function mediated by immunosuppressive drugs or delayed immune reconstitution. Disturbed T cell control of Epstein-Barr virus (EBV)-infected B cells leads to posttransplant lymphoproliferative disorder (PTLD) in up to 10% of patients. Children are at a higher risk because they are more often EBV-naïve before transplantation. Patients with PTLD often present with unspecific symptoms (pain and organ/graft dysfunction). Depending on the onset of PTLD, manifestations vary between mainly nodal (late PTLD) and extranodal sites (early PTLD). Histology, immunohistology, EBER in situ hybridization and molecular pathology are required for diagnosis and subclassification of PTLD. The three major types are early lesions (resembling reactive proliferations in immunocompetent patients), polymorphic PTLD (proliferation of B and T cells with effacement of histoarchitecture) and monomorphic PTLD (presenting as malignant lymphomas, mainly high-grade B cell lymphomas). In a subfraction of cases, including monomorphic PTLD, reduction of immunosuppressive medication alone is sufficient to induce remission. Surgical debulking of tumor mass and anti-CD20-antibody treatment with or without chemotherapy (usually at lower dosages than in immunocompetent patients) constitute the basis of additional therapy.

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“…Most reported descriptions of T-and NK-cell posttransplant lymphoproliferative disorder (100 to 200 cases) were single case reports, and few reports included > 3 patients. [4][5][6]10,13 A higher incidence of posttransplant lymphoproliferative disorder may occur in children than adults because children typically are seronegative for Epstein-Barr virus. 12 …”

Section: Discussionmentioning

confidence: 99%

“…13 In T-cell posttransplant lymphoproliferative disorder, favorable prognostic factors include T-cell large granular lymphocytic leukemia, young age, and the combination of chemotherapy/radiation therapy and reduced immunosuppression; poor prognosis is associated with hepatosplenic T-cell lymphoma subtype or involvement of bone marrow, central nervous system, or the graft. 14 The prognosis for T-cell posttransplant lymphoproliferative disorder usually is poor; however, the prognosis for T-ALL occurring after transplant is unknown because of the lack of well-documented cases.…”

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confidence: 99%

Untitled

2014

Exp Clin Transplant

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T-cell posttransplant lymphoproliferative disorders after solid-organ transplant are rare and may be clinically aggressive. A 3-year-old boy had liver transplant from his grandfather because of hepatoblastoma. The immunosuppressive regimen was based on tacrolimus and prednisolone. At 22 months after transplant (age, 5 years), the patient presented to the hospital because of severe cough. Computed tomography scan of the chest showed a large left mediastinal mass (9 × 7.2 × 7 cm) and left pleural effusion. A Tru-Cut biopsy of the mediastinal mass showed diffuse infiltration with blast cells, and the diagnosis of T-cell acute lymphoblastic leukemia was made. Immunohistochemical examination of blasts showed strong and diffuse terminal deoxynucleotidyl transferase and CD3 antibody expression; Ki-67 proliferation index was > 95%, and tumor cells were negative for Epstein-Barr virus. Tacrolimus was stopped, sirolimus was started, and chemotherapy was given, but he died 2 months after diagnosis because of chemotherapy-induced sepsis. Monomorphic T-cell posttransplant lymphoproliferative disorder with features of acute lymphoblastic leukemia and lymphoblastic lymphoma is rare after liver transplant.

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Risk Factors and Prognosis in T-Cell Posttransplantation Lymphoproliferative Diseases

Abstract: T-PTLD is a heterogeneous group of different aberrant T-cell proliferations and represents a significant complication following transplantation, showing a uniformly poor prognosis.

Cited by 50 publications

References 110 publications

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Posttransplant Lymphoproliferative Disorder in Pediatric Patients

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