Adult T-Cell Leukemia/Lymphoma in a Renal Transplant Recipient: An Opportunistic Occurrence

Abstract

A 42-year-old man with chronic renal failure and homograft transplantation developed adult T cell lymphoma in one native kidney. The role of transfusion in the acquisition of human T-lymphotropic virus type I and its role in the early development of adult T cell lymphoma, particularly on the background of chronic immunosuppression, are discussed. To our knowledge, this is the first such case.

Clinicopathological features of cutaneous lesions of adult T-cell leukaemia/ lymphoma

“…15,16 Three studies have documented the development of ATLL during immunosuppressive therapy in renal transplant recipients. [17][18][19] On the other hand, in patients with cutaneous T-cell lymphoma (CTCL), especially those with early stage CTCL, polyclonal T-cell populations were detected in tissue DNA. For example, two different identical TCR gene rearrangement bands were identified in one patient, thus describing two groups of patients with early stage mycosis fungoides (MF): those with a monoclonal T-cell neoplasm and those with polyclonal lymphoproliferative MF.…”

Infection with human T lymphotropic virus type I in organ transplant donors and recipients in Spain

“…Several cases of development of ATL in HTLV-I positive recipients following transplantation have been reported [Zanke et al, 1989;Tsurumi et al, 1992;Williams et al, 1994]. However, two prospective studies conducted among 31 Japanese HTLV-I positive recipients of kidney allografts have not recorded cases of HTLV-I-related diseases after an average follow-up of 8-10 years [Nakamura et al, 1998;Tanabe et al, 1998], and it was concluded that immunosuppression does not seem to favor the development of ATL nor TSP.…”

High Grade Lymphoma in a Post-Renal Transplant Patient

“…In patients with EBV, active chronic infection and high titers of antibodies against both the viral capside and the surface antigen and low or negative titers against the nuclear antigen, immature T lymphocytes expressing CD2 for EBV could become infected [14]. The association of T-NHL with other viruses like HTLV-I has been described [15,16]. As for its localization, 69% are extranodal.…”

“…Before the introduction of CyA, the CNS was the most frequently involved (multicentric in 25% of cases) although after the introduction of CyA the most common site was the thoraco-abdominal region [2]. The involvement rate of the transplanted reaches 18% and is related to the treatment with OKT-3 [16].…”

“…Subtypes found are lymphoblastic, immunoblastic, mixed diffuse, CD30 Ki + , NK-like (hepatosplenic gamma delta lymphoma, lymphoproliferative disease with granular lymphocytes, big T-cell leukemia) [3,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”