Epstein-Barr Virus-Negative Lymphoproliferative Disorders in Long-Term Survivors After Heart, Kidney, and Liver Transplant1

Dotti, Gianpietro; Fiocchi, R; Motta, Teresio; Gamba, Amando; Gotti, Eliana; Gridelli, Bruno; Borleri, Gianmaria; Manzoni, Cristina; Viero, Piera; Remuzzi, Giuseppe; Barbui, Tiziano; Rambaldi, Alessandro

doi:10.1097/00007890-200003150-00027

Cited by 148 publications

(104 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In heart recipients, mortality from lymphoma was even higher -50% in the first year -and no improvement in survival was noted between patients transplanted recently or earlier ( Figure 8B). Contrary to claims in the literature (22,23,28,29) the time to development of lymphoma did not prognosticate survival in kidney or heart recipients. Five-year survival was 41.4% (n = 125) and 37.0% (n = 575) for kidney recipients whose tumors developed in <90 days or >365 days, respectively (p = NS); the corresponding 5-year survival rates in heart recipients were 33.3% (n = 42) and 30.0% (n = 398) (p = NS).…”

Section: Patient Survivalcontrasting

confidence: 99%

“…Several reports have suggested differences between the clinical and biological characteristics of lymphomas that develop early or late after transplantation. Late-appearing lymphomas frequently lack EBV genome sequences, were reported to respond poorly to reduction or discontinuation of immunosuppression, and generally are believed to have a poorer outcome (22,23,28,29). In contrast to these reports, our data suggest that lymphomas have a poor outcome regardless of time of appearance after transplantation.…”

Section: Lymphomas After Solid Organ Transplantationcontrasting

confidence: 89%

“…Reduction or discontinuation of immunosuppressive therapy has led to lymphoma regression, albeit with variable response rates (20,21). Early onset lymphomas, which are often EBV-positive and polymorphic, are more likely to respond to this strategy (22), whereas late-onset, monomorphic, monoclonal, EBV-negative lymphomas were often found to be unresponsive and have been associated with a worse prognosis (23,24).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

957

779

View full text Add to dashboard Cite

We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200 000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p < < 0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.

show abstract

Section: Patient Survivalcontrasting

confidence: 99%

Section: Lymphomas After Solid Organ Transplantationcontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

957

779

View full text Add to dashboard Cite

show abstract

“…Two distinct groups of PTLD have been identified based on the time between transplant and the development of PTLD. Early onset PTLD develops within the first year after transplantation, while late-onset PTLD develops during the second year or later (4). Early PTLDs are pathologically and clinically heterogeneous, but EBV proteins or EBV-encoded RNA are usually detectable in tumor cells (5).…”

Section: Discussionmentioning

confidence: 99%

Use of Serum Protein Electrophoresis to Monitor Patients with Post-transplant Lymphoproliferative Disorder

Aqui

Tomaszewski

Goodman

et al. 2003

American Journal of Transplantation

View full text Add to dashboard Cite

Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of solid organ transplantation. Reduction in immunosuppression is usually the first line of therapy and is often curative. While undergoing treatment, imaging studies including MRI and CT scans are commonly used to follow the disease course. Laboratory studies such as lactate dehydrogenase and Epstein-Barr virus PCR can also be used to monitoring disease status. We report here a case of PTLD developing 48 months post renal transplant. A monoclonal protein (M protein) was demonstrated at diagnosis with a corresponding antibody expressed on the malignant lymphocytes. The patient was followed with serial serum protein electrophoreses (SPEP) to monitor his response to therapy. The amount of M protein paralleled the disease course, decreasing as the clinical symptoms improved. This case illustrates the utility of using SPEP to monitor patients with PTLD.

show abstract

“…81,82 EBV negative PTLD is associated with later onset, monomorphic histology and aggressive clinical behavior similar to lymphomas in immuno competent patients. 83 Risk factors for PTLD include Epstein-Barr virus seronegativity at transplant, younger age, intensity of immunosuppression and the first year posttransplant. In patients diagnosed with PTLD, management options include reduction of immunosuppression, rituximab, combination chemotherapy, and adoptive immunotherapy.…”

Section: Development Of De Novo Malignancies and Posttransplant Lymphmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

show abstract

Epstein-Barr Virus-Negative Lymphoproliferative Disorders in Long-Term Survivors After Heart, Kidney, and Liver Transplant1

Cited by 148 publications

References 47 publications

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Use of Serum Protein Electrophoresis to Monitor Patients with Post-transplant Lymphoproliferative Disorder

Current Status of Immunosuppression in Liver Transplantation

Contact Info

Product

Resources

About