Skip to main content

Advertisement

SpringerLink
Log in

Monomorphic Post-transplant Lymphoproliferative Disorder After Kidney Transplantation and Hematopoietic Stem Cell Transplantation: Clinicopathological Characteristics, Treatments and Prognostic Factors

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Post-transplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of lymphoid neoplasms associated with immunosuppression following transplantation. Among PTLDs, monomorphic PTLD (m-PTLD) is the largest category; however, its characteristics and survival outcome are not fully understood because of low incidence. This study enrolled 30 adult patients with m-PTLD after kidney-transplantation (KT, n = 17) and hematopoietic stem cell transplantation (HSCT, n = 13) from January 1998 to December 2014. The incidence rates of m-PTLD were 0.74 and 3.63% in the KT and HSCT groups, respectively. M-PTLD patients in the HSCT group were younger and showed earlier onset, with EBV-encoded small RNAs (EBER) more frequently identified. Diffuse large B cell lymphoma (DLBCL) was the main pathological type, and the digestive system was the most extranodal involvement site in m-PTLD after KT and HSCT. Among the 28 patients with DLBCL m-PTLD,the complete remission rate after rituximab treatment was higher than in patients not administered rituximab treatment (P = 0.038). With a median follow-up of 46 months after m-PTLD diagnosis, the estimated 5-year overall survival (OS) was 59.2 ± 9.1% in all patients, and 64.2 ± 11.8 and 52.7 ± 14.1% in the KT and HSCT groups, respectively (P = 0.741). ECOG PS, Ann Arbor stage, and CD68 IHC expression were independent prognostic factors for OS. M-PTLD is a rare but serious complication after transplantation. Ongoing efforts to standardize safe and effective treatment protocols would improve the poor overall survival. The independent prognostic factors contributed to risk-stratified treatment, and might be validated by larger studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Swerdlow SH, Campo E, Harris NL (2008) WHO classification of tumours of haematopoietic and lymphoid tissues. IARC Press, Lyon

    Google Scholar 

  2. Végso G, Hajdu M, Sebestyén A (2011) Lymphoproliferative disorders after solid organ transplantation-classification, incidence, risk factors, early detection and treatment options. Pathol Oncol Res 17:443–454

    Article  PubMed  Google Scholar 

  3. Taylor AL, Marcus R, Bradley JA (2005) Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 56:155–167

    Article  PubMed  Google Scholar 

  4. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  5. Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, Rosenberg SA, Coltman CA, Tubiana M (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 7:1630–1636

    Article  CAS  PubMed  Google Scholar 

  6. Canioni D, Salles G, Mounier N, Brousse N, Keuppens M, Morchhauser F, Lamy T, Sonet A, Rousselet MC, Foussard C, Xerri L (2008) High numbers of tumor-associated macrophages have an adverse prognostic value that can be circumvented by rituximab in patients with follicular lymphoma enrolled onto the GELA-GOELAMS FL-2000 trial. J Clin Oncol 26:440–446

    Article  CAS  PubMed  Google Scholar 

  7. Chang KL, Chen YY, Shibata D, Weiss LM (1992) Description of an in situ hybridization methodology for detection of Epstein-Barr virus RNA in paraffin-embedded tissues, with a survey of normal and neoplastic tissues. Diagn Mol Pathol 1:246–255

    Article  CAS  PubMed  Google Scholar 

  8. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A, Cabanillas F, Klippensten D, Hiddemann W, Castellino R, Harris NL, Armitage JO, Carter W, Hoppe R, Canellos GP (1999) Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI sponsored international working group. J Clin Oncol 17:1244

    Article  CAS  PubMed  Google Scholar 

  9. Opelz G, Döhler B (2004) Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant 42:222–230

    Article  Google Scholar 

  10. Dierickx D, Tousseyn T, Sagaert X, Fieuws S, Wlodarska I, Morscio J, Brepoels L, Kuypers D, Vanhaecke J, Nevens F, Verleden G, Van Damme-Lombaerts R, Renard M, Pirenne J, De Wolf-Peeters C, Verhoef G (2013) Single-center analysis of biopsy-confirmed posttransplant lymphoproliferative disorder: incidence, clinicopathological characteristics and prognostic factors. Leuk Lymphoma 54:2433–2440

    Article  PubMed  Google Scholar 

  11. Heslop HE (2009) How I treat EBV lymphoproliferation. Blood 114:4002–4008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Stuhlmann-Laeisz C, Oschlies I, Klapper W (2014) Detection of EBV in reactive and neoplastic lymphoproliferations in adults-when and how? J Hematopathol 7:165–170

    Article  Google Scholar 

  13. Trappe R, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S, PTLD German Study Group, European PTLD Network, German PTLD Study Group, European PTLD Network (2012) Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell posttransplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol 13:196–206

    Article  CAS  PubMed  Google Scholar 

  14. Farinha P, Masoudi H, Skinnider BF, Shumansky K, Spinelli JJ, Gill K, Klasa R, Voss N, Connors JM, Gascoyne RD (2005) Analysis of multiple biomarkers shows that lymphoma-associated macrophage (LAM) content is an independent predictor of survival in follicular lymphoma (FL). Blood 106:2169–2174

    Article  CAS  PubMed  Google Scholar 

  15. Tan KL, Scott DW, Hong F, Kahl BS, Fisher RI, Bartlett NL, Advani RH, Buckstein R, Rimsza LM, Connors JM, Steidl C, Gordon LI, Horning SJ, Gascoyne RD (2012) Tumor-associated macrophages predict inferior outcomes in classic Hodgkin lymphoma: a correlative study from the E2496 Intergroup trial. Blood 120:3280–3287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Johnson LR, Nalesnik MA, Swerdlow SH (2006) Impact of Epstein-Barr virus in monomorphic B-cell posttransplant lymphoproliferative disorders: a histogenetic study. Am J Surg Pathol 30:1604–1612

    Article  PubMed  Google Scholar 

  17. Pourfarziani V, Taheri S, Lessan-Pezeshki M, Nourbala MH, Simforoosh N, Nemati E, Makhdoomi K, Ghafari A, Ahmadpour P, Nafar M, Einollahi B (2008) Lymphoma after living donor kidney transplantation: an Iranian multicenter experience. Int Urol Nephrol 40:1089–1094

    Article  PubMed  Google Scholar 

  18. Evens AM, David KA, Helenowski I, Nelson B, Kaufman D, Kircher SM, Gimelfarb A, Hattersley E, Mauro LA, Jovanovic B, Chadburn A, Stiff P, Winter JN, Mehta J, Van Besien K, Gregory S, Gordon LI, Shammo JM, Smith SE, Smith SM (2010) Multicenter analysis of 80 solid organ transplantation recipients with posttransplantation lymphoproliferative disease: outcomes and prognostic factors in the modern era. J Clin Oncol 28:1038–1046

    Article  PubMed  PubMed Central  Google Scholar 

  19. Leblond V, Dhedin N, Mamzer Bruneel MF, Choquet S, Hermine O, Porcher R, Nguyen Quoc S, Davi F, Charlotte F, Dorent R, Barrou B, Vernant JP, Raphael M, Levy V (2001) Identification of prognostic factors in 61 patients with posttransplantation lymphoproliferative disorders. J Clin Oncol 19:772–778

    Article  CAS  PubMed  Google Scholar 

  20. Ghobrial IM, Habermann TM, Maurer MJ, Geyer SM, Ristow KM, Larson TS, Walker RC, Ansell SM, Macon WR, Gores GG, Stegall MD, McGregor CG (2005) Prognostic analysis for survival in adult solid organ transplant recipients with posttransplantation lymphoproliferative disorders. J Clin Oncol 23:7574–7582

    Article  PubMed  Google Scholar 

  21. Hourigan MJ, Doecke J, Mollee PN, Gill DS, Norris D, Johnson DW, Gandhi MK (2008) A new prognosticator for post-transplant lymphoproliferative disorders after renal transplantation. Br J Haematol 141:904–907

    Article  PubMed  Google Scholar 

  22. Caillard S, Porcher R, Provot F, Dantal J, Choquet S, Durrbach A, Morelon E, Moal V, Janbon B, Alamartine E, Pouteil Noble C, Morel D, Kamar N, Buchler M, Mamzer MF, Peraldi MN, Hiesse C, Renoult E, Toupance O, Rerolle JP, Delmas S, Lang P, Lebranchu Y, Heng AE, Rebibou JM, Mousson C, Glotz D, Rivalan J, Thierry A, Etienne I, Moal MC, Albano L, Subra JF, Ouali N, Westeel PF, Delahousse M, Genin R, Hurault de Ligny B, Moulin B (2013) Posttransplantation lymphoproliferative disorder after kidney transplantation: report of a nationwide French registry and the development of a new prognostic score. J Clin Oncol 31:1302–1309

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Capital Medical University, Beijing Friendship Hospital, Beijing, China

    Li Fu, Jianlan Xie, Jun Lin, Jingshi Wang, Na Wei, Dayong Huang, Tingting Wang, Jing Shen, Xiaoge Zhou & Zhao Wang

Authors
  1. Li Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jianlan Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jingshi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Na Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dayong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tingting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jing Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiaoge Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zhao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhao Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no potential conflicts of interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fu, L., Xie, J., Lin, J. et al. Monomorphic Post-transplant Lymphoproliferative Disorder After Kidney Transplantation and Hematopoietic Stem Cell Transplantation: Clinicopathological Characteristics, Treatments and Prognostic Factors. Indian J Hematol Blood Transfus 33, 492–499 (2017). https://doi.org/10.1007/s12288-017-0799-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-017-0799-7

Keywords

Search

Navigation