Clinicopathologic spectrum and EBV status of post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation
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Post-transplant lymphoproliferative disorders (PTLDs) are serious, life-threatening complications of solid-organ transplantation (SOT) and bone marrow transplantation, and are associated with high mortality. PTLDs represent a heterogeneous group of lymphoproliferative diseases, which show a spectrum of clinical, morphologic, and molecular genetic features ranging from reactive polyclonal lesions to frank lymphomas. We describe clinicopathologic features of 17 cases of PTLD after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which were analyzed by in situ hybridization for EBV and a panel of antibodies directed against numerous antigens, including CD20, PAX5, CD3, bcl-6, CD10, MUM-1/IRF4, CD138, Kappa, Lambda, CD30, CD15, and Ki67. The cases included 13 males and 4 females with a median age of 31 years (range 9–49 years) and the PTLDs developed 1.5–19 months post-transplant (mean 4.7 months). The histological types indicated five cases of early lesions, two of plasmacytic hyperplasia and three of infectious mononucleosis-like PTLD. Eight cases were polymorphic PTLD, and four were monomorphic PTLD, including three of diffuse large B cell lymphoma, and one of plasmablastic lymphoma. Foci and sheets of necrosis were observed in five cases. The infected ratio of EBV was 88.2 %. Some cases were treated by reduction of immunosuppression, antiviral therapy, donor lymphocyte infusion, or anti-CD20 monoclonal rituximab. Eight cases died. The first half year after allo-HSCT is very important for the development of PTLD. The diagnosis of PTLD relies on morphology and immunohistochemistry, and EBV plays an important role in the pathogenesis of PTLD. The prognosis of PTLD is poor, and, notably, PTLD after allo-HSCT exhibits some features different from those of PTLD after SOT.
- Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporine-steroid therapy. Lancet. 1984;1:583–7. CrossRef
- Swerdlow SH, Webber SA, Chadburn A, et al. Post-transplant lymphoproliferative disorders. In: Swerdlow SH, Campo E, Harris NL, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2008. p. 343–9.
- Zhang YN, Zhou XG, Wang CZ, et al. Clinicopathologic study of post-transplant lymphoproliferative disorders. Chin J Pathol. 2006;35(4):209–11.
- Mucha K, Foroncewicz B, Ziarkiewicz-Wroblewska B, et al. Post-transplant lymphoproliferative disorders in view of the new WHO classification: a more rational approach to a protean disease? Nephrol Dial Transplant. 2010;25:2089–98. CrossRef
- Opelz G, Dohler B. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant. 2003;4:222–30. CrossRef
- Opelz G, Henderson R. Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients. Lancet. 1993;342:1514–6. CrossRef
- Curtis RE, Travis LB, Rowlings PA, et al. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study. Blood. 1999;94:2208–16.
- Hoegh-Petersen M, Goodyear D, Geddes MN, et al. High incidence of post transplant lymphoproliferative disorder after antithymocyte globulin-based conditioning and ineffective prediction by day 28 EBV-specific T lymphocyte counts. Bone Marrow Transplant. 2011;46:1104–12. CrossRef
- Kamani N, Kumar S, Hassebroek A, et al. Malignancies after hematopoietic cell transplantation for primary immune deficiencies: a report from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant. 2011;17:1783–9. CrossRef
- Xu LP, Huang XJ, Liu DH, et al. A clinical study of lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation. Chin J Intern Med. 2007;46(12):996–9.
- Xu LP, Liu DH, Liu KY, et al. The efficacy and safety of donor lymphocyte infusion to treat Epstein–Barr virus associated lymphoproliferative diseases after allogeneic hematopoietic stem cell transplantation. Chin J Intern Med. 2010;49(11):955–8.
- Johnson LR, Nalesnik MA, Swerdlow SH. Impact of Epstein–Barr virus in monomorphic B-cell posttransplant lymphoproliferative disorders. A histogenetic study. Am J Surg Pathol. 2006;30(12):1604–12. CrossRef
- Tsao L, His ED. The clinicopathologic spectrum of posttransplantation lymphoproliferative disorders. Arch Pathol Lab Med. 2007;131:1209–18.
- Ibrahim HAH, Naresh KN. Posttransplant lymphoproliferative disorders. Adv Hematol. 2012;2012:1–11. CrossRef
- Knowles DM, Cesarman E, Chadburn A, et al. Correlative morphologic and molecular genetic analysis demonstrates three distinct categories of posttransplantation lymphoproliferative disorders. Blood. 1995;85(2):552–65.
- Wu TT, Swerdlow SH, Locker J, et al. Recurrent Epstein–Barr virus-associated lesions in organ transplant recipients. Hum Pathol. 1996;27(2):157–64. CrossRef
- Borenstein J, Pezzella F, Gatter KC. Plasmablastic lymphomas may occur as post-transplant lymphoproliferative disorders. Histopathology. 2007;51:774–7. CrossRef
- Trappe R, Zimmermann H, Fink S, et al. Plasmacytoma-like post-transplant lymphoproliferative disorder, a rare subtype of monomorphic B-cell post-transplant lymphoproliferative, is associated with a favorable outcome in localized as well as in advanced disease: a prospective analysis of 8 cases. Haematologica. 2011;96(7):1067–71. CrossRef
- Harris NL, Swerdlow SH, Frizzera GF, et al. Post-transplant lymphoproliferative disorders. In: Jaffe ES, Harris NL, Stein H, et al., editors. WHO classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 264–9.
- Gibson SE, Swerdlow SH, Craig FE, et al. EBV-positive extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in the posttransplant setting: a distinct type of posttransplant lymphoproliferative disorders? Am J Surg Pathol. 2011;35(6):807–15. CrossRef
- Opelz G, Dohler B. Impact of HLA mismatching on incidence of posttransplant at non-Hodgkin lymphoma after kidney transplantation. Transplantation. 2010;89:567–72. CrossRef
- Landgren O, Gilbert ES, Rizzo JD, et al. Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation. Blood. 2009;113(20):4992–5001. CrossRef
- Kamiura T, Miyamoto T, Kawano N, et al. Successful treatment by donor lymphocyte infusion of adult T-cell leukemia/lymphoma relapse following allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2012;95(6):725–30. CrossRef
- Clinicopathologic spectrum and EBV status of post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation
International Journal of Hematology
Volume 97, Issue 1 , pp 117-124
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Hematopoietic stem cell transplantation
- Post-transplant lymphoproliferative disorders
- Diffuse large B cell lymphoma
- Epstein–Barr virus
- Industry Sectors
- Author Affiliations
- 1. Department of Pathology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
- 2. Institute of Hematology, Peking University People’s Hospital, Beijing, People’s Republic of China