Identification of high-risk monomorphic post-transplant lymphoproliferative disorder following solid organ transplantation

Voorhees, Timothy J.; Kannan, Kavya; Galeotti, Jonathan; Grover, Natalie S; Vaidya, Rakhee; Moore, Dominic T.; Montgomery, Nathan D.; Beaven, Anne; Dittus, Christopher

doi:10.1080/10428194.2020.1821006

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…21 Recent work also suggests increased copy number of MYC is associated with worse outcomes. 22 EBVnegative PTLD appears biologically and pathologically distinct from EBV-positive PTLD, with frequent TP53 mutations, and in some studies is associated with poor outcome although data on this are mixed. [23][24][25][26][27] Frontline chemotherapy in the United States used for the management of high-grade, aggressive B-cell non-Hodgkin lymphomas (NHL) such as DLBCL and BL uses a Lymphomes Malins B (LMB) backbone that incorporates a minimum of four cycles of intensive chemotherapy, including potentially highly nephrotoxic doses of methotrexate and high rates of infectious complications.…”

Section: Discussionmentioning

confidence: 99%

“…Lesions with MYC translocations and/or BL histology make up a distinct and clinically aggressive group of PTLD that have poor outcomes without the use of conventional chemotherapy 21 . Recent work also suggests increased copy number of MYC is associated with worse outcomes 22 . EBV‐negative PTLD appears biologically and pathologically distinct from EBV‐positive PTLD, with frequent TP53 mutations, and in some studies is associated with poor outcome although data on this are mixed 23–27 .…”

Section: Discussionmentioning

confidence: 99%

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Treatment of posttransplant lymphoproliferative disorder with poor prognostic features in children and young adults: Short‐course EPOCH regimens are safe and effective

Rubinstein

Shah

Breese

et al. 2021

Pediatric Blood & Cancer

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No guidelines exist for which intensive chemotherapy regimen is best in pediatric or young adult patients with high-risk posttransplant lymphoproliferative disorder (PTLD). We retrospectively reviewed patients with PTLD who received intervalcompressed short-course etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (SC-EPOCH) regimens at our institution. Eight patients were included with median age of 12 years. All patients achieved a complete response with a manageable toxicity profile. Two patients developed second, clonally unrelated, EBV-positive PTLD and one patient had recurrence at 6 months off therapy. No graft rejection occurred during therapy. All eight patients are alive with median follow-up of 29 months.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of posttransplant lymphoproliferative disorder with poor prognostic features in children and young adults: Short‐course EPOCH regimens are safe and effective

Rubinstein

Shah

Breese

et al. 2021

Pediatric Blood & Cancer

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“…In particular, TP53 mutations, which have been associated with increased FDG-uptake, are more frequently reported in monomorphic PTLD [30,32]. Other genetic abnormalities in monomorphic PTLD, which may account for the increase in SUV, include the increased BCL2/MYC expression and BCL2/BCL6/MYC rearrangements [33]. Therefore, differences in mutation landscape as well as microenvironment may be one of the drivers responsible for the differences in glucose metabolism across PTLD subtypes.…”

Section: Discussionmentioning

confidence: 99%

Semi-Quantitative Characterization of Post-Transplant Lymphoproliferative Disorder Morphological Subtypes with [18F]FDG PET/CT

Jesus

Vergote

Noordzij

et al. 2021

JCM

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Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation classified according to the WHO as nondestructive, polymorphic, monomorphic, and classic Hodgkin Lymphoma subtypes. In this retrospective study, we investigated the potential of semi-quantitative 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/computed tomography (CT)-based parameters to differentiate between the PTLD morphological subtypes. Methods: 96 patients with histopathologically confirmed PTLD and baseline [18F]FDG PET/CT between 2009 and 2019 were included. Extracted semi-quantitative measurements included: Maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean). Results: Median SUVs were highest for monomorphic PTLD followed by polymorphic and nondestructive subtypes. The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD (17.8, interquartile range (IQR):16) than in polymorphic subtypes (9.8, IQR:13.4) and nondestructive (4.1, IQR:6.1) (p = 0.04 and p ≤ 0.01, respectively). An SUVpeak ≥ 24.8 was always indicative of a monomorphic PTLD in our dataset. Nevertheless, there was a considerable overlap in SUV across the different morphologies. Conclusion: The median SUVpeak at the biopsy site was significantly higher in monomorphic PTLD than polymorphic and nondestructive subtypes. However, due to significant SUV overlap across the different subtypes, these values may only serve as an indication of PTLD morphology, and SUV-based parameters cannot replace histopathological classification.

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“…Viral reactivation events typically will be resuppressed by immune system as chemotherapy course is completed, and recovery to a normal immune environment is established. In transplant patients, lymphoproliferative disorders (LPDs) are observed in 2-10% patients [2][3][4][5]. For EBV-associated LPD events, rituximab is an effective therapeutic option which targets CD20 EBV+ cells [6].…”

Section: Introductionmentioning

confidence: 99%

Epstein Barr Virus-Positive Lymphoproliferative Disorder Following Lymphodepletion for MAGE A4 Adoptive Cellular Therapy in a Patient with Synovial Sarcoma: A Case Report

Zhou,

Jawed,

Ganjoo

2023

Case Rep Oncol

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Lymphoproliferative disorder (LPD) associated with viral reactivation is a known risk of immunocompromised patients. With development of novel cellular therapies utilizing lymphodepletion regimens in advanced cancer, the risk of LPDs should be a consideration. Here, we report a case of a 61-year-old treated male with history of metastatic synovial sarcoma and multiple treatment lines treated with cell therapy (lymphodepleting chemotherapy and afami-cel, formerly ADP-A2M4, T-cell treatment) on clinical study that developed Epstein Barr virus-positive LPD. Patient was treated with rituximab and achieved a complete response. New cellular therapies present promising treatment options for patients and adverse events should be monitored carefully.

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Identification of high-risk monomorphic post-transplant lymphoproliferative disorder following solid organ transplantation

Cited by 4 publications

References 27 publications

Treatment of posttransplant lymphoproliferative disorder with poor prognostic features in children and young adults: Short‐course EPOCH regimens are safe and effective

Treatment of posttransplant lymphoproliferative disorder with poor prognostic features in children and young adults: Short‐course EPOCH regimens are safe and effective

Semi-Quantitative Characterization of Post-Transplant Lymphoproliferative Disorder Morphological Subtypes with [18F]FDG PET/CT

Epstein Barr Virus-Positive Lymphoproliferative Disorder Following Lymphodepletion for MAGE A4 Adoptive Cellular Therapy in a Patient with Synovial Sarcoma: A Case Report

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