Posttransplant T-cell lymphoproliferative disorders - An aggressive, late complication of solid-organ transplantation

被引:130
作者
Hanson, MN
Morrison, VA
Peterson, BA
Stieglbauer, KT
Kubic, VL
McCormick, SR
McGlennen, RC
Manivel, JC
Brunning, RD
Litz, CE
机构
[1] UNIV MINNESOTA HOSP & CLIN, DEPT LAB MED, MINNEAPOLIS, MN 55455 USA
[2] UNIV MINNESOTA HOSP & CLIN, DEPT PATHOL & INTERNAL MED, MINNEAPOLIS, MN 55455 USA
[3] VET AFFAIRS MED CTR, HEMATOL ONCOL SECT, MINNEAPOLIS, MN USA
[4] VET AFFAIRS MED CTR, INFECT DIS SECT, MINNEAPOLIS, MN USA
[5] HENNEPIN CTY MED CTR, DEPT PATHOL, MINNEAPOLIS, MN USA
[6] UNITED HOSP, DEPT PATHOL, ST PAUL, MN USA
关键词
D O I
10.1182/blood.V88.9.3626.bloodjournal8893626
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
T-cell non-Hodgkin's lymphomas are an uncommon occurrence after solid-organ transplantation. We describe a morphologically and immunophenotypically distinct group of T-cell lymphoproliferative disorders that occurred late in the course of six patients with solid-organ transplants. The patients ranged in age from 31 to 56 years (median, 43). Three were male; all were splenectomized. The interval from transplant to the diagnosis of lymphoma ranged from 4 to 26 years (median, 15). Symptoms at presentation were related to sites of involvement. Pulmonary, marrow, and CNS involvement were present in five, four, and one case, respectively, No patient had lymphadenopathy. Five patients had an elevated lactate dehydrogenase level (range, 226 to 4,880 IU/L: median, 1,220 IU/L). Five of six patients had a leukoerythroblastic reaction. All cases had large-cell histology and frequently contained cytoplasmic granules. Those cases tested expressed CD2, CD3, and CD8 and were negative for B-cell antigens. T-cell receptor beta- and gamma-chain genes were clonally rearranged in three of three and one of three cases, respectively, All T-cell posttransplant lymphoproliferative disorders (T-PTLDs) studied were negative for Epstein-Barr virus (EBV), human T-cell leukemia/lymphoma virus type 1 (HTLV-1), human T-cell leukemia/lymphoma virus type 2 (HTLV-2), and human herpes virus type 8 (HHV-8) genomes. Treatment with acyclovir (three patients) or chemotherapy (three patients) resulted in two responses. All patients had an aggressive course, with a median survival duration of 5 weeks. In conclusion, a clinically aggressive T-PTLD may be a late complication of solid-organ transplantation and does not appear to be related to EBV, HTLV 1, HTLV-2, or HHV-8 infection. (C) 1996 by The American Society of Hematology.
引用
收藏
页码:3626 / 3633
页数:8
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