Hodgkin's disease following solid organ transplantation

Bierman, Philip J.; Vose, Julie M.; Langnas, Alan Norman; Rifkin, R. M.; Hauke, R. J.; Smir, Bassam N.; Greiner, Timothy C.

doi:10.1093/oxfordjournals.annonc.a010570

Cited by 50 publications

(29 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 Published data on treatment outcomes is scarce and limited to case reports and small retrospective series. 37,38 The picture is further complicated by the histological subtypes of Hodgkin lymphoma and the different management of limited versus disseminated disease in immunocompetent patients. Consistent with published guidelines 11 and mirroring treatment of Hodgkin disease in the immunocompetent host, we use immunosuppression reduction followed by radiotherapy in stage I disease and systemic chemotherapy (ABVD [doxorubicin, bleomycin, vinblastine, dacarbazine]) as tolerated in stage II, III, or IV disease.…”

Section: Hodgkin and Hodgkin-like Ptld Hodgkin And Hodgkin-likementioning

confidence: 99%

“…It should be noted that ABVD in PTLD is associated with significant (infectious) mortality both in our own experience and in the published case series. 37,38 Plasmablastic PTLD. Plasmablastic lymphoma (PBL) was first described as a usually EBV-associated B-cell neoplasm with immunoblastic morphology, the immunophenotype of plasma cells and loss of mature B-cell antigens arising in the oral mucosa of HIV-positive patients.…”

Section: Hodgkin and Hodgkin-like Ptld Hodgkin And Hodgkin-likementioning

confidence: 99%

See 1 more Smart Citation

EBV and posttransplantation lymphoproliferative disease: what to do?

Zimmermann¹,

Trappe

2013

Hematology

View full text Add to dashboard Cite

This review summarizes the available evidence and outlines our approach to the prophylaxis and management of posttransplantation lymphoproliferative disorder (PTLD) in adult solid organ transplantation recipients. We attempt to reduce immunosuppression as tolerated in every patient with suspected PTLD in close cooperation with their transplantation physician. There is no evidence to guide the decision when to initiate further treatment; we usually wait no longer than 4 weeks and always initiate further therapy unless there is a complete or at least good partial remission. If clinical and histological findings indicate rapidly progressive disease, we initiate additional therapy significantly earlier. CD20-positive PTLD accounts for approximately 75% of PTLD cases. Outside of clinical trials, we currently regard sequential therapy with rituximab and CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone/ prednisolone) chemotherapy as standard evidence-based treatment for CD20-positive PTLD unresponsive to immunosuppression. We also discuss our approach to the rare instance of adults with PTLD associated with primary EBV infection, localized (stage I) disease, rare PTLD subtypes, and refractory/relapsed disease based on the available retrospective data and our own experience. In addition to immunotherapy and chemotherapy, this includes local therapy approaches such as surgery and radiotherapy in stage I disease, plasmacytoma-like PTLD, and primary CNS PTLD. We also provide our view on the current indications for the use of allogeneic cytotoxic T cells, even though this treatment modality is so far unavailable in our clinical practice.

show abstract

Section: Hodgkin and Hodgkin-like Ptld Hodgkin And Hodgkin-likementioning

confidence: 99%

Section: Hodgkin and Hodgkin-like Ptld Hodgkin And Hodgkin-likementioning

confidence: 99%

EBV and posttransplantation lymphoproliferative disease: what to do?

Zimmermann¹,

Trappe

2013

Hematology

View full text Add to dashboard Cite

show abstract

“…65,85,[96][97][98][99][100][101][102][103][104][105] EBV lymphoproliferative disease post transplant may manifest as isolated hepatitis, lymphoid interstitial pneumonitis or meningo-encephalitis or as an infectious mononucleosis (IM)-like syndrome with peripheral adenopathy, fever and/or hepatitis. Frequently, the definition of PTLD is limited to lymphomatous lesions (localized or diffuse) that are often extranodal (often in the allograft).…”

Section: Post-transplant Ebv-lpdmentioning

confidence: 99%

“…greater than 2 years post transplant, and conventional Hodgkin's disease chemotherapy has been successful in treating these patients. 102 The use of adoptive T cell therapy in an organ transplant recipient is complex. First, cadaveric organs are most widely utilized; therefore, donor leukocytes are often not available.…”

Section: Risk Factors For Ptldmentioning

confidence: 99%

Atypical Lymphoproliferative Diseases

Greiner¹

2000

Hematology

View full text Add to dashboard Cite

This review addresses the clinical presentation, pathology, and therapy of several uncommon lymphoid proliferations. Because these lymphoproliferations span the characteristics of reactive polymorphous proliferations to clonal malignant neoplasms, they are often difficult to diagnose and treat effectively.In Section I, Dr. Greiner describes the pathology of the spectrum of atypical lymphoid disorders including Castleman's disease, angioimmunoblastic lymphadenopathy, lymphadenopathy in autoimmune diseases, posttransplant lymphoproliferative disorders, and X-linked lymphoproliferative disorder. The relationship to Epstein-Barr virus (EBV) and human herpsesvirus-8 (HHV-8) is discussed, and molecular diagnostic assays and principles for obtaining proper diagnostic evaluation are emphasized.In Section II, Dr. Armitage presents a practical approach to the management of Castleman's disease. The discussion includes the importance of confirmation of the histological diagnosis and careful staging evaluation, therapeutic options, and the increased risks for infection and lymphoma. The appropriate roles of surgical excision, corticosteroids, and combination chemotherapy are addressed along with alternative strategies such as anti-interleukin-6 and bone marrow transplantation.In Section III, Dr. Gross reviews the treatment of EBV-associated lymphoproliferative disorders in primary immunodeficiencies and in post-transplant patients. He gives an update on the recent molecular discoveries in X-linked lymphoproliferative disorder. Preliminary results of a phase II trial of low-dose cyclophosphamide in posttransplant lymphoproliferative disorders and the use of GM-CSF as preemptive therapy are presented.

show abstract

“…1,2 The majority of PTLD are of B cell origin; however, cases of T cell PTLD and Hodgkin's disease have been reported. [2][3][4] Pathologically, the lymphoproliferation encompasses a spectrum ranging from plasma cell hyperplasia and polymorphic B cell hyperplasia (similar to infectious mononucleosis), to monomorphic infiltrates indistinguishable from malignant lymphoma. 2,5,6 The risk for developing PTLD after solid organ transplantation is increased 20-to 150-fold compared to the incidence of lymphoma in the general population.…”

mentioning

confidence: 99%

Epstein–Barr virus-associated lymphoproliferative disorder after autologous bone marrow transplantation: report of two cases

Hauke

Greiner

Smir

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Epstein-Barr virus-associated lymphoproliferative disorders have been frequently reported as a complication of solid organ and allogeneic bone marrow transplantation. Their occurrence is rare after autologous bone marrow transplantation (BMT) with only five published reports in the literature. We report two cases of posttransplant lymphoproliferative disorder occurring after autologous BMT for Hodgkin's disease and non-Hodgkin's lymphoma. Post-transplant lymphoproliferative disorders can occur after autologous BMT and should be included in the differential diagnosis of patients with persistent fever, adenopathy or pulmonary infiltrates. Keywords: PTLD; EBV; BMT; lymphoproliferation Post-transplant lymphoproliferative disorders (PTLD) are a well recognized complication of solid organ transplantation and are due to an unrestricted proliferation of Epstein-Barr virus (EBV)-infected lymphocytes occurring with immunosuppression.1,2 The majority of PTLD are of B cell origin; however, cases of T cell PTLD and Hodgkin's disease have been reported. [2][3][4] Pathologically, the lymphoproliferation encompasses a spectrum ranging from plasma cell hyperplasia and polymorphic B cell hyperplasia (similar to infectious mononucleosis), to monomorphic infiltrates indistinguishable from malignant lymphoma. 2,5,6 The risk for developing PTLD after solid organ transplantation is increased 20-to 150-fold compared to the incidence of lymphoma in the general population. The risk is greatest within the first year after transplant. [7][8][9] PTLD have been reported after allogeneic bone marrow transplantation (BMT) with an increased incidence after T cell depletion. 10,11 In contrast to the experience with PTLD after allogeneic BMT, PTLD after autologous BMT is infrequent.12-15 We present two patients who developed PTLD after autologous BMT.Correspondence: Dr RJ Hauke, Department of Internal Medicine, University of Nebraska Medical Center, 600 S 42nd Street, Omaha NE 68198-8065, USA Received 30 September 1997; accepted 27 January 1998 Case reports Patient 1A 27-year-old male with stage IIA nodular sclerosing Hodgkin's disease relapsed after treatment with doxorubicin, bleomycin, vincristine and dacarbazine. He received two cycles of mechlorethamine, vincristine, procarbazine and prednisone (MOPP) and then received high-dose cyclophosphamide, carmustine and etoposide followed by autologous BMT. Following transplant, 4500 cGy consolidation radiation therapy was given to the mediastinum.On day +87, he developed dyspnea and bilateral pulmonary infiltrates. Bronchoalveolar lavage was nondiagnostic. Low grade fevers and dyspnea persisted after empiric antibiotic therapy.After referral to our institution, a video-assisted thoracoscopy was performed. Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) pneumonitis were diagnosed.Sulfamethoxazole/trimethroprim, ganciclovir (2.5 mg/kg every 8 h i.v.), immune globulin and prednisone were administered with prompt clinical improvement. Recurrent pneumothoraces required pleural stri...

show abstract

Hodgkin's disease following solid organ transplantation

Abstract: Hodgkin's disease occurring in the post-transplantation period should probably be treated like Hodgkin's disease in non-immunosuppressed patients. Prolonged disease-free survival is possible and function of the transplanted organ can be preserved.

Cited by 50 publications

References 19 publications

EBV and posttransplantation lymphoproliferative disease: what to do?

EBV and posttransplantation lymphoproliferative disease: what to do?

Atypical Lymphoproliferative Diseases

Epstein–Barr virus-associated lymphoproliferative disorder after autologous bone marrow transplantation: report of two cases

Contact Info

Product

Resources

About