Successive Occurrence of T-Cell and B-Cell Lymphomas after Renal Transplantation in a Patient with Multiple Cutaneous Squamous-Cell Carcinomas

Euvrard, Sylvie; Noble, Claire Pouteil; Kanitakis, Jean; Ffrench, Martine; Berger, Françoise; Delecluse, Henri Jacques; D’Incan, M.; Thivolet, J; Touraine, Jean Louis

doi:10.1056/nejm199212313272706

Cited by 58 publications

(47 citation statements)

References 12 publications

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“…The coexistence of both B-and T-cell clones in the same lesion has been previously documented in post-transplant lymphoproliferative disorders, but only as case reports. 7,9 The reports on coexisting B-and T-cell clones include two with metachronous B-cell post-transplant lymphoproliferative disorders and T-cell post-transplant lymphoproliferative disorders, 5,11 presence of concurrent T-and B-cell post-transplant lymphoproliferative disorders at different sites, 10 simultaneous presence of EBV-positive B-cell posttransplant lymphoproliferative disorders and T-cell post-transplant lymphoproliferative disorders, 6 and a case of cutaneous EBV-driven B-cell posttransplant lymphoproliferative disorders with concomitant peripheral blood T-cell clones. 8 Two cases of EBV-negative cutaneous anaplastic large-cell lymphoma with dual T-and B-cell receptor gene rearrangements have also been reported.…”

Section: Discussionmentioning

confidence: 99%

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Presence of monoclonal T-cell populations in B-cell post-transplant lymphoproliferative disorders

et al. 2011

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As has been previously shown, the lack of immune surveillance plays a major role in the unchecked proliferation of Epstein-Barr virus (EBV)-infected B cells in the pathogenesis of B-cell post-transplant lymphoproliferative disorders. We hypothesised that the lack of immune surveillance should possibly also affect T cells, and this should lead to subsequent emergence of T-cell clones. The presence of both B-and T-cell clones in post-transplant lymphoproliferative disorders samples has rarely been demonstrated in the past. We systematically evaluated 26 B-cell post-transplant lymphoproliferative disorder, 23 human immune deficiency virus-associated B-cell lymphoma and 10 immune-competent diffuse large B-cell lymphoma samples for B-and T-cell clonality (polymerase chain reaction and heteroduplex analysis using BIOMED-2 protocol), T-cell subsets (immunohistochemistry) and EBV association (in situ hybridisation using EBER). One-half of B-cell posttransplant lymphoproliferative disorders showed evidence of monoclonal T-cell expansion, and among the T cells present in the tissue samples, CD8-positive cells predominated. Although 9/13 (69%) B-cell posttransplant lymphoproliferative disorders with the presence of monoclonal T-cell population had a CD4:CD8 ratio of r0.4, 0/13 of the cases without monoclonal T-cell expansion had a ratio r0.4 (P ¼ 0.002). Only 2/26 (8%) demonstrated significant cytological atypia in the CD3/CD8-positive cells. There was no association between EBV and presence of T-cell clones. T-cell clones were not identified in lymphomas other than B-cell post-transplant lymphoproliferative disorders. Among 53.8% cases of EBV-positive B-cell post-transplant lymphoproliferative disorders with associated clonal expansion of T-cells tested, none had EBV-positive T cells. We conclude that half of B-cell post-transplant lymphoproliferative disorders are associated with clonal expansion of CD8-positive T cells, most of which do not amount to the coexistence of a T-cell post-transplant lymphoproliferative disorders.

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Posttransplant lymphoproliferative disorders harbouring both B-and T-cell clones in the same patient are extremely rare and there are only a few cases reported in the literature so far. [5][6][7][8][9][10][11][12][13] EBV plays an important role in driving the proliferation ( Table 1).…”

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Presence of monoclonal T-cell populations in B-cell post-transplant lymphoproliferative disorders

et al. 2011

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“…On the other hand, co-existing T-cell and B-cell malignancies in post-transplant patients are rare and only five cases of synchronous and metachronous T-cell and B-cell PTLD, including the current case, have been reported so far [2][3][4][5] (Table I). It remains unclear whether the emergence of T-cell clones is a host reaction triggered by monoclonal B-cell proliferation (EBV-infected or otherwise) or is secondary to failure of immune surveillance.…”

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confidence: 75%

Metachronous B‐cell and T‐cell post‐transplant lymphoproliferative disorders with features of chronic active Epstein–Barr virus infection

Liu

Tan

et al. 2015

American J Hematol

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To The Editor: We report an unusual case of metachronous T-cell post-transplant lymphoproliferative disease (PTLD) with clinicopathologic manifestations resembling chronic active Epstein-Barr virus (CAEBV) infection of T/NK subtype and hemophagocytic lymphohistiocytosis (HLH), more than 4 years following the occurrence of B-cell PTLD.A 15 year-old Chinese girl, in end-stage renal failure since 13 years of age from chronic glomerulonephritis, received a cadaveric donor Epstein-Barr virus (EBV)-unknown to recipient-seronegative renal transplant. She received EBV prophylaxis with oral valganciclovir.Five months post-transplant, she developed exudative tonsillitis and underwent tonsillectomy. Histology of the tonsils revealed a diffuse, destructive, and polymorphous lymphoid infiltrate composed of lymphoid cells showing a full range of B-cell maturation. The lymphoid cells were positive for CD20, CD79A, and showed kappa light chain restriction (Supporting Information Fig. 1). In situ hybridization for Epstein-Barr virusencoded small ribonucleic acid (EBER) was positive in B-cells but not T-cells. Features were consistent with EBV-positive PTLD, polymorphic type. Positron emission tomography-computed tomography (PET-CT) scan showed an intensely fluorodeoxyglucose (FDG)-avid soft tissue mass lesion in the nasopharynx and posterior nasal cavity associated with retropharyngeal and cervical adenopathy. Plasma EBV DNA by polymerase chain reaction (PCR) was 134 copies per lg DNA (reference <100 copies per lg DNA). Throat swab EBV DNA was 1,225 copies per lg DNA. She was treated with intravenous rituximab and immunoglobulin with continued antiviral therapy. Immunosuppression was reduced with tacrolimus weaned to minimal levels. Repeat PET-CT scan following tonsillectomy showed resolution of the FDG-avid lesions.In the ensuing period from 2 to 3 years post-transplant, the patient experienced recurrent episodes of pancytopenia which required treatment with granulocyte-colony stimulating factor. Throughout this period, her EBV viral load remained high (1,500-2,500 copies per lg DNA) while surveillance PET-CT scans were negative for metabolically active lesions. The cause of the pancytopenia was attributed to persistent EBV viremia with marrow suppression.Four years and 6 months post-transplant, the patient was treated for acute cellular rejection with intravenous pulse methylprednisolone. A month later, she developed high fevers, epistaxis, and spontaneous bruising. Physical examination revealed hepatosplenomegaly, cervical lymphadenopathy, and lower limb ecchymoses. Investigations showed pancytopenia with haemoglobin 7.1 g/dL, total white cell count 2.72 3 10

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“…As a rule, the other tumors involved are virusrelated neoplasias (Kaposi's sarcoma, carcinomas of the esophagus, liver, vulva, vagina and cervix) [1,2]. Some cases of successively or concomitantly developing tumors have been described [3][4][5].…”

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“…Subtypes found are lymphoblastic, immunoblastic, mixed diffuse, CD30 Ki + , NK-like (hepatosplenic gamma delta lymphoma, lymphoproliferative disease with granular lymphocytes, big T-cell leukemia) [3,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

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confidence: 99%

High Grade Lymphoma in a Post-Renal Transplant Patient

Bustillo

Melon

Glz

et al. 2000

Nephron

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Successive Occurrence of T-Cell and B-Cell Lymphomas after Renal Transplantation in a Patient with Multiple Cutaneous Squamous-Cell Carcinomas

Cited by 58 publications

References 12 publications

Presence of monoclonal T-cell populations in B-cell post-transplant lymphoproliferative disorders

Presence of monoclonal T-cell populations in B-cell post-transplant lymphoproliferative disorders

Metachronous B‐cell and T‐cell post‐transplant lymphoproliferative disorders with features of chronic active Epstein–Barr virus infection

High Grade Lymphoma in a Post-Renal Transplant Patient

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