J Korean Med Sci.  2006 Apr;21(2):259-264. 10.3346/jkms.2006.21.2.259.

Clinical Characteristics and Outcomes of Posttransplant Lymphoproliferative Disorders Following Allogeneic Hematopoietic Stem Cell Transplantation in Korea

Affiliations
  • 1Department of Internal Medicine, The Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea. fire@catholic.ac.kr

Abstract

Between 1995 and 2003, seven cases of posttransplant lymphoproliferative disorder (PTLD) were identified among 1,116 patients who received allogeneic hematopoietic stem cell transplantations (HSCT) at Catholic HSCT Center (overall incidence 0.6%). Five (71.4%) patients had episodes of acute graft-versus-host-disease (GVHD) and were treated with steroids. Cervical lymphadenopathy was observed in most cases (71.4%), but clinical symptoms varied depending on the involved sites. Pathologic findings varied: 1 case of plasmacytic hyperplasia, 3 of polymorphic PTLD, 2 of diffuse large B-cell lymphoma, 1 of large T-cell lymphoma, which proved to be associated with Epstein-Barr virus (EBV). The proportion of EBV-negative PTLD was 33.3%. Five patients demonstrated a good response to treatment (treatment response rate 71.4%). The overall mortality was 42.8%, and one death was directly attributable to PTLD. The incidence of PTLD is expected to increase, based on the rising use of grafts from alternative donors and recent clinical features of PTLD manifested by a disseminated and fulminant nature. It is necessary to have a high level of suspicion when monitoring patients and readily adopt prompt and effective cellular immunotherapy for PTLD.

Keyword

Lymphoproliferative Disorders; Hematopoietic Stem Cell Transplantation; Transplantation; Homologous

MeSH Terms

Transplantation, Homologous
Middle Aged
Male
Lymphoproliferative Disorders/*etiology/pathology/therapy
Lymphoma, T-Cell/etiology
Lymphoma, Large-Cell, Diffuse/etiology
Lymphoma, Large-Cell/etiology
Lymphoma, B-Cell/etiology
Korea
Humans
Hematopoietic Stem Cell Transplantation/*adverse effects
Female
Epstein-Barr Virus Infections/etiology
Adult
Adolescent

Cited by  1 articles

A Case Report of Posttransplant Lymphoproliferative Disorders Successfully Treated with R-CHOP in Korea
Sul Hee Yoon, Soo Jeong Kim, Hye Won Lee, Doh Yu Hwang, Jin Seok Kim, June-Won Cheong, Yoo Hong Min
Korean J Hematol. 2008;43(2):106-112.    doi: 10.5045/kjh.2008.43.2.106.


Reference

1. Loren AW, Porter DL, Stadtmauer EA, Tsai DE. Posttransplant lymphoproliferative disorder: a review. Bone Marrow Translpant. 2003. 31:145–155.
Article
2. Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000. 343:481–490.
Article
3. Preiksaitis JK, Cockfield SM. Bowden RA, Ljungman P, Paya CV, editors. Epstein-Barr virus and lymphoproliferative disease after hematopoietic stem cell or solid organ tranplantation. Transplant infections. 2003. 2nd ed. Philadelphia: Lippincott-Williams & Wilkins;326–349.
4. Gottschalk S, Rooney CM, Heslop HE. Post-transplant lymphoproliferative disorders. Annu Rev Med. 2005. 56:29–44.
Article
5. Zutter MM, Martin PJ, Sale GE, Shulman HM, Fisher L, Thomas ED, Durnam DM. Epstein-Barr virus lymphoproliferation after bone marrow transplantation. Blood. 1988. 72:520–525.
Article
6. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA, Lerner KG, Thomas ED. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HLA-matched sibling donors. Transplantation. 1974. 18:295–304.
Article
7. Kingma DW, Medeiros LJ, Barletta J, Raffeld M, Mann RB, Ambinder RF, Jaffe ES. Epstein-Barr virus is infrequently identified in non-Hodgkin's lymphoma associated with Hodgkin's disease. Am J Surg Pathol. 1994. 18:48–61.
8. Harris NL, Swerdlow SH, Frizzera G, Knowles DM. Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. Post-transplant lymphoproliferative disorders (PTLD) pathology and genetics: tumours of haematopoietic and lymphoid tissues. WHO classification of tumours. 2001. Lyons, France: IARC Press;264–269.
9. Preiksaitis JK. New developments in the diagnosis and management of posttransplantation lymphoproliferative disorders in solid organ transplant recipients. Clin Infect Dis. 2004. 39:1016–1023.
Article
10. Green M. Management of Epstein-Barr virus-induced post-transplant lymphoproliferative disease in recipients of solid organ transplantation. Am J Transplant. 2001. 1:103–108.
Article
11. Micallef IN, Chhanabhai M, Gascoyne RD, Shepherd JD, Fung HC, Nantel SH, Toze CL, Klingemann HG, Sutherland HJ, Hogge DE, Nevill TJ, Le A, Barnett MJ. Lymphoproliferative disorders following allogeneic bone marrow transplantation: the Vancouver experience. Bone Marrow Transplant. 1998. 22:981–987.
Article
12. Curtis RE, Travis LB, Rowlings PA, Socie G, Kingma DW, Banks PM, Jaffe ES, Sale GE, Horowitz MM, Witherspoon RP, Shriner DA, Weisdorf DJ, Kolb HJ, Sullivan KM, Sobocinski KA, Gale RP, Hoover RN, Fraumeni JF Jr, Deeg HJ. Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study. Blood. 1999. 94:2208–2216.
13. Juvonen E, Aalto SM, Tarkkanen J, Volin L, Mattila PS, Knuutila S, Ruutu T, Hedman K. High incidence of PTLD after non-T-cell-depleted allogeneic haematopoietic stem cell transplantation as a consequence of intensive immunosuppressive treatment. Bone Marrow Transplant. 2003. 32:97–102.
Article
14. Nalesnik MA. The diverse pathology of post-transplant lymphoproliferative disorders: the importance of a standardized approach. Transpl Infect Dis. 2001. 3:88–96.
Article
15. Dockrell DH, Strickler JG, Paya CV. Epstein-Barr virus-induced T cell lymphoma in solid organ transplant recipients. Clin Infect Dis. 1998. 26:180–182.
Article
16. van Gorp J, Doornewaard H, Verdonck LF, Klopping C, Vos PF, van den Tweel JG. Posttransplant T-cell lymphoma, report of three cases and a review of the literature. Cancer. 1994. 73:3064–3072.
Article
17. Hanson MN, Morrison VA, Peterson BA, Stieglbauer KT, Kubic VL, McCormick SR, McGlennen RC, Manivel JC, Brunning RD, Litz CE. Posttransplant T cell lymphoproliferative disorders: an aggressive, late complication of solid-organ transplantation. Blood. 1996. 88:3626–3633.
18. Zutter MM, Durnam DM, Hackman RC, Loughran TP Jr, Kidd PG, Ashley RL, Petersdorf EW, Martin PJ, Thomas ED. Secondary T-cell lymphoproliferation after marrow transplantation. Am J Clin Pathol. 1990. 94:714–721.
Article
19. Wang LC, Lu MY, Yu J, Jou ST, Chiang IP, Lin KH, Lin DT. T cell lymphoproliferative disorder following bone marrow transplantation for severe aplastic anemia. Bone Marrow Transplant. 2000. 26:893–897.
Article
20. Yufu Y, Kimura M, Kawano R, Noguchi Y, Takatsuki H, Uike N, Ohshima K. Epstein-Barr virus-associated T cell lymphoproliferative disorder following autologous blood stem cell transplantation for relapsed Hodgkin's disease. Bone Marrow Transplant. 2000. 26:1339–1341.
Article
21. Chuhjo T, Yachie A, Kanegane H, Kimura H, Shiobara S, Nakao S. Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder simultaneously affecting both B and T cells after allogeneic bone marrow transplantation. Am J Hematol. 2003. 72:255–258.
Article
22. Thorly-Lawson DA, Gross A. Persistence of the Epstein-Barr virus and the origin of associated lymphomas. N Engl J Med. 2004. 350:1328–1337.
23. Nelson BP, Nalesnik MA, Bahler DW, Locker J, Fung JJ, Swerdlow SH. Epstein-Barr virus-negative post-transplant lymphoproliferative disorders: A distinct entity? Am J Surg Pathol. 2000. 24:375–385.
24. Leblond V, Davi F, Charlotte F, Dorent R, Bitker MO, Sutton L, Gandjbakhch I, Binet JL, Raphael M. Post-transplant lymphoproliferative disorders not associated with Epstein-Barr virus: a distinct entity? J Clin Oncol. 1998. 16:2052–2059.
Article
25. Gross TG, Streinbuch M, Defor T, Shapiro RS, McGlave P, Ramsay NK, Wagner JE, Filipovich AH. B cell lymphoproliferative disorders following hematopoietic stem cell transplantation: risk factors, treatment and outcome. Bone Marrow Transplant. 1999. 23:251–258.
Article
26. Straathof KC, Savoldo B, Heslop HE, Rooney CM. Immunotherapy for post-transplant lymphoproliferative disease. Br J Hematol. 2002. 118:728–740.
Article
27. van Esser JW, Niesters HG, van der Holt B, Meijer E, Osterhaus AD, Gratama JW, Verdonck LF, Lowenberg B, Cornelissen JJ. Prevention of Epstein-Barr virus lymphoproliferative disease by molecular monitoring and preemptive rituximab in high-risk patients after allogenic stem cell transplantation. Blood. 2002. 99:4364–4369.
28. Smets F, Latinne D, Bazin H, Reding R, Otte JB, Buts JP, Sokal EM. Ratio between Epstein-Barr viral load and anti-Epstein-Barr virus specific T-cell response as a predictive marker of post-transplant lymphoproliferative disease. Transplantation. 2002. 73:1603–1610.
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