A single-center experience of post-transplant lymphomas involving the central nervous system with a review of current literature

Abstract

BackgroundCentral Nervous System (CNS) lymphoma is a rare presentation of post-transplantation lymphoproliferative disorder (PTLD).MethodsThis single center retrospective study reviewed presentations, management and outcomes of CNS lymphomas in kidney transplant patients transplanted 1968 to 2015, and reviews relevant current literature.ResultsWe identified 5773 adult kidney transplant recipients of who 90 had a PTLD diagnosis confirmed. CNS disease was diagnosed in 6/90 (7%). Median age at presentation was 60 years and time from transplant 4.5 years. Immunosuppression at diagnosis included mycophenolate mofetil and prednisolone without calcineurin inhibitor in 5/6 patients. Histological analysis diagnosed monomorphic disease in 5/6, and one polymorphic case with tissue positive for Epstein-barr virus (EBV) in 5/6 cases. Despite this 2/4 EBV positive cases had no detectable EBV in peripheral blood or CSF at diagnosis. Treatment strategies included reduction in immunosuppression in all, chemotherapy (n=5), radiotherapy (n=3), Cytotoxic T-Lymphocytes and Craniotomy (n=2). Patient survival was 40% at 1 year with CTL treated patients surviving beyond three years from diagnosis.ConclusionThis study supports observational data suggesting MMF treated patients without CNI may have increased risk of disease. Peripheral blood screening for EBV DNAemia does not seem helpful in early identification of those at risk.

Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review

“…RT total dose and technique were not reported and 6-mo OS was 66.6%. This study supports observational data suggesting that patients treated with mycophenolate mofetil and without calcineurin inhibitor may have increased risk of cancer after transplantation[ 27 ].…”

“…Velvet et al [ 27 ] conducted a single center retrospective study on management and outcomes of central nervous system lymphomas in 6 kidney transplant patients. During the lymphoma treatment, immunosuppressive therapy was reduced in all patients.…”

“…The present systematic review showed that in kidney transplant recipients developing cancer and undergoing RT, clear evidence on improved function of the graft and/or of patients survival after modulating or withdrawing immunosuppressive therapy, as opposed to continuing maintenance immunosuppression, is lacking; conversely, only few retrospective studies on small RT-treated cancer cohorts are available, mainly including PCa patients, without comparison between different immunosuppressive strategies[ 26 , 27 ]. RT appears to be a feasible therapeutic option also in this setting, with oncological outcomes not clearly different from the general patient population[ 28 ].…”

Incidence and mortality of post‐transplant lymphoproliferative disorders after kidney transplantation: A real‐world retrospective analysis in Japan

“…1a). Previous investigations suggested an increase in the incidence of primary CNS PTLD due to the introduction of new immunosuppressive agents 24 . Crane et al .…”

Successful treatment of CNS involvement in a patient with widely disseminated PTLD through the addition of intrathecal methotrexate to standard therapy

“…[1][2][3][4][8][9][10] When compared to other sites of disease, CNS-PTLD is more likely to be EBV-associated, monomorphic, and have B-cell origins. 1,2,5,11 For the majority of patients, CNS-PTLD occurs without concurrent systemic involvement and presents radiographically with multifocal periventricular lesions. 1,2,5,12 Only 10% of patients with biopsy-proven CNS-PTLD have positive cytology.…”