Clinicopathologic spectrum and EBV status of post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation

Abstract

Post-transplant lymphoproliferative disorders (PTLDs) are serious, life-threatening complications of solid-organ transplantation (SOT) and bone marrow transplantation, and are associated with high mortality. PTLDs represent a heterogeneous group of lymphoproliferative diseases, which show a spectrum of clinical, morphologic, and molecular genetic features ranging from reactive polyclonal lesions to frank lymphomas. We describe clinicopathologic features of 17 cases of PTLD after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which were analyzed by in situ hybridization for EBV and a panel of antibodies directed against numerous antigens, including CD20, PAX5, CD3, bcl-6, CD10, MUM-1/IRF4, CD138, Kappa, Lambda, CD30, CD15, and Ki67. The cases included 13 males and 4 females with a median age of 31 years (range 9-49 years) and the PTLDs developed 1.5-19 months post-transplant (mean 4.7 months). The histological types indicated five cases of early lesions, two of plasmacytic hyperplasia and three of infectious mononucleosis-like PTLD. Eight cases were polymorphic PTLD, and four were monomorphic PTLD, including three of diffuse large B cell lymphoma, and one of plasmablastic lymphoma. Foci and sheets of necrosis were observed in five cases. The infected ratio of EBV was 88.2 %. Some cases were treated by reduction of immunosuppression, antiviral therapy, donor lymphocyte infusion, or anti-CD20 monoclonal rituximab. Eight cases died. The first half year after allo-HSCT is very important for the development of PTLD. The diagnosis of PTLD relies on morphology and immunohistochemistry, and EBV plays an important role in the pathogenesis of PTLD. The prognosis of PTLD is poor, and, notably, PTLD after allo-HSCT exhibits some features different from those of PTLD after SOT.

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“…5 The frequency of PTLD is greater after lung (5% to 20%) than kidney (1% to 3%) transplant. 9 In the present study, the frequency of developing PTLD was greater after liver (2.9%) than kidney transplant (0.9%).…”

Gastrointestinal pathology in transplant patients

“…Three case reports described a monomorphic population of lymphoid cells, which is therefore in keeping with monomorphic PTLD . A recent series described a case each of gastric and small intestinal PTLD, both with polymorphic rather than monomorphic features . The mucosa of the small intestinal case was reported to show ‘mucosal erosion, glandular destruction and apoptosis in residual glands, therefore consistent with GvHD’ .…”

EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases

“…Four patients had CD20-negative plasmablastic lymphoma, a malignancy that is commonly seen in T-cell immunosuppressed individuals infected with HIV, 8 and that has been marginally described in recipients of stem cell transplants. 19,20 In this regard, the early period after UCBT is characterized by deep immune suppression with low levels of CD4 þ T cells that could favor the development of this complication. 19 One strength of the present study is the fact that clonality was evaluated in all cases.…”