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Posttransplant Lymphoma A Single-Center Experience of 500 Liver Transplantations
- Source :
- Medical Oncology. 21:273-284
- Publication Year :
- 2004
- Publisher :
- Springer Science and Business Media LLC, 2004.
-
Abstract
- Background: Posttransplant lymphoproliferative disease (PTLD) is a serious complication after organ transplantation associated with a high mortality, and is often caused by a primary or reactivated Epstein-Barr virus (EBV) infection. The incidence of PTLD ranges from 1% to 10%, depending on the type of organ transplanted and the immunosuppressive regimens used. Methods: In this retrospective study from a single center, 12 (2.4%) of 500 consecutive recipients of liver grafts developed lymphoma. Patient data were obtained by chart review. All diagnostic biopsies were reviewed by two hematopathologists. Results: The median time between transplantation and the diagnosis of lymphoma was 19.5 (1.5–148) mo. Nine of the patients had been treated with OKT-3 and/or ATG after the transplantation. Two patients had a pretransplant diagnosis of lymphoma. The PTLD was of high grade in all patients, and was associated with EBV in 6 of 9 examined cases. No relation with human herpesvirus-8 could be detected. In all patients, immuno-suppression was reduced at the time of lymphoma diagnosis. Chemotherapy was used in all patients, mostly upfront but in one patient after lymphoma progression after reduction of immunosuppression. Nine patients also got antiviral therapy. Immunotherapy with the monoclonal antibody rituximab was used in one patient. Half of the patients are alive, in complete continuous remission, more than 4 yr after the lymphoma diagnosis. Two patients died of neutropenic sepsis, three of persistent lymphoma, and one of recurrent cirrhosis while in complete remission. Conclusions: PTLD is a significant complication in liver-transplanted patients. Intensive chemotherapy can induce long-term remissions in a substantial number of patients. The role for monoclonal antibodies in this setting should be investigated further.
- Subjects :
- Graft Rejection
Male
Epstein-Barr Virus Infections
Cancer Research
Pathology
Time Factors
Lymphoma
medicine.medical_treatment
Liver transplantation
Single Center
Gastroenterology
Organ transplantation
Antibodies, Monoclonal, Murine-Derived
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
Hematology
Remission Induction
Antibodies, Monoclonal
Immunosuppression
Herpesviridae Infections
General Medicine
Middle Aged
Treatment Outcome
Oncology
Vincristine
Child, Preschool
Herpesvirus 8, Human
Female
Rituximab
Immunosuppressive Agents
medicine.drug
Adult
medicine.medical_specialty
Antineoplastic Agents
Internal medicine
medicine
Humans
Cyclophosphamide
Retrospective Studies
Immunosuppression Therapy
business.industry
Infant
medicine.disease
Liver Transplantation
Transplantation
Doxorubicin
Prednisone
business
Subjects
Details
- ISSN :
- 13570560
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Medical Oncology
- Accession number :
- edsair.doi.dedup.....fc52ec4fd3647ecf13e8bfa874be2c38