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Annals of Hematology

, 89:97 | Cite as

Post-rituximab Burkitt transformation of PTLD: loss of CD20 expression accompanied by a switch in light-chain expression

  • Yu-Yan Hwang
  • Kai Y. Wong
  • Rock Y. Y. Leung
  • Simon H. M. Wong
  • See-Ching Chan
  • Gopesh Srivastava
  • Wing Y. AuEmail author
Letter to the Editor

Dear Editor,

A 53-year-old woman, with cadaveric liver transplant for primary biliary cirrhosis 7 years ago, presented with generalized lymphadenopathy (Fig.  1a). A biopsy showed post-transplantation lymphoproliferative disease (PTLD; Fig.  1b). The lymphoma cells expressed CD20, CD79a, κ-chain, and Epstein Barr virus-encoded RNA (EBER). Her bone marrow examination was normal but a serum immunoelectrophoresis showed a monoclonal protein (IgGλ 8.2 g/l). Cyclosporin was stopped, and she was treated with R-CEOP × 6 (rituximab, cyclophosphamide, epirubicin, vincristine, and prednisolone). This was followed by acute liver rejection, requiring tacrolimus, prednisolone, and mycophenolate mofetil treatment. A remission lasted for 4 years, with undetectable circulating EBV-DNA and monoclonal protein. However, she relapsed with fever, renal shutdown, and hepatosplenomegaly (Fig.  1c). A marrow aspirate showed sheets of Burkitt-like cells (Fig.  1d), expressing CD19, CD22, CD23, EBER, and λ-chain,...

Keywords

Tacrolimus Primary Biliary Cirrhosis Mycophenolate Mofetil Chain Primer Monoclonal Protein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Yu-Yan Hwang
    • 1
  • Kai Y. Wong
    • 2
  • Rock Y. Y. Leung
    • 2
  • Simon H. M. Wong
    • 3
  • See-Ching Chan
    • 4
  • Gopesh Srivastava
    • 2
  • Wing Y. Au
    • 1
    Email author
  1. 1.Department of MedicineQueen Mary HospitalHong KongChina
  2. 2.Department of PathologyQueen Mary HospitalHong KongChina
  3. 3.Department of RadiologyQueen Mary HospitalHong KongChina
  4. 4.Department of SurgeryQueen Mary HospitalHong KongChina

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