Successful treatment of a classic Hodgkin lymphoma‐type post‐transplant lymphoproliferative disorder with tailored chemotherapy and Epstein–Barr virus‐specific cytotoxic T lymphocytes in a pediatric heart transplant recipient

Abstract

CHL type is the least common major form of EBV-related PTLD but rarely occurs in pediatric recipients; development of CHL subsequent to other PTLD subtypes in the same transplant recipient is even more unusual. Because of its rarity, indications on the best treatment strategy are limited. Patients have been mostly treated with standard HL chemotherapy/radiotherapy, and prognosis seems more favorable than other monomorphic PTLDs. Herein, we describe a pediatric case of EBV-associated, stage IV-B, CHL arising in a heart allograft recipient eight yr after diagnosis of B-cell polymorphic PTLD. The patient was successfully treated with adjusted-dose HL chemotherapy and autologous EBV-specific CTL, without discontinuation of maintenance immunosuppression. At two yr from therapy completion, the patient is in CR with stable organ function. With this strategy, it may be possible to reproduce the good prognostic data reported for CHL-type PTLD, with decreased risk of organ toxicity or rejection.

Treatment and outcomes in classic Hodgkin lymphoma post‐transplant lymphoproliferative disorder in children

“…Additionally, programmed cell death protein 1 (PD‐1) blockade poses as a potential treatment option, due to upregulation of PD‐L1 by EBV. A combination of low‐dose chemotherapy with EBV‐specific cytotoxic T‐cell lymphocytes was also reported to be effective in a case report of HL‐PTLD after heart transplant . Risks of using checkpoint inhibitors include secondary toxicities, such as allograft rejection or acquired autoimmunity.…”

“…A combination of low-dose chemotherapy with EBVspecific cytotoxic T-cell lymphocytes was also reported to be effective in a case report of HL-PTLD after heart transplant. 17 Risks of using checkpoint inhibitors include secondary toxicities, such as allograft rejection or acquired autoimmunity. Further study of the efficacy and toxicity of these new agents may provide more targeted and less toxic therapy for both HL and HL-PTLD.…”

High-dose Chemotherapy with Stem Cell Rescue Provided Durable Remission for Classical Hodgkin Lymphoma-type Post-transplant Lymphoproliferative Disorder after Unrelated Cord Blood Transplantation: A Case Report and Review of the Literature

“…CHL-type PTLD was previously reported to develop in recipients with other preceding PTLD subtypes, mainly polymorphic-type PTLD ( 6 ); however, difficulties were associated with clarifying the relationship between preceding polymorphic-type and CHL-type PTLDs. In our case, although preceding polymorphic-type PTLD included a small number of large cells as immunoblasts with the expression of PAX5, the immunohistochemical examination did not reveal any expression of CD30 or EBER, indicating a less-common manifestation of these cells between polymorphic-type and CHL-type PTLDs.…”

Hodgkin lymphoma post‐transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival

“…Data on the treatment of HL‐PTLD is even more scant and has been primarily restricted to case reports and case series totaling 39 patients . Chemotherapy has been commonly administered, although follow‐up varied greatly across reports.…”

“…Disease outcomes and prognostication for patients who develop HL‐PTLD are not well described. Most available data on the treatment of HL‐PTLD have been reported in case reports and small series , and thus, there is minimal guidance when evaluating and treating this unique patient population. One registry study identified 60 patients with HL‐PTLD in renal transplant recipients, all of whom were diagnosed prior to 2001 .…”