Management of post‐transplant lymphoproliferative disorder in adult solid organ transplant recipients – BCSH and BTS Guidelines

Parker, Anne; Bowles, Kristian M.; Bradley, J. Andrew; Emery, Vincent C.; Featherstone, C.; Gupte, Girish; Marcus, Robert; Parameshwar, Jayan; Ramsay, Alan D.; Newstead, Charles G.

doi:10.1111/j.1365-2141.2010.08160.x

Cited by 191 publications

(174 citation statements)

References 83 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…En el momento del diagnóstico se debe hacer tomografía computarizada de cuello, tórax, abdomen y pelvis, para clasificar la extensión, evaluar la estrategia de tratamiento y como base para el seguimiento de la respuesta. Los estudios de imágenes del sistema nervioso central y el del líquido cefalorraquídeo se hacen según la indicación clínica (5,28). La tomografía computarizada por emisión de positrones (PET-CT) puede ser una alternativa útil, especialmente en los casos de presentaciones atípicas, tanto para evaluar el estadio como para el seguimiento, especialmente en los linfomas B difusos de células grandes y en los linfomas Hodgkin (23,29).…”

Section: Estudio Sugerido Para Los Pacientes Con Sospecha De Elptunclassified

“…En todos los pacientes se recomienda reducir la inmunosupresión al menor nivel tolerado (usualmente 25 % a 50 % del basal) (28). Las guías americanas previas recomiendan en enfermedad limitada una reducción del 25 % de la inmunosupresión, en pacientes crítica-mente enfermos disminuir la ciclosporina/tacrolimus al 50 %, descontinuar el antimetabolito y mantener la prednisona a dosis de 7,5-10 mg/día; y en enfermedad extensa, suspender la inmunosupresión excepto la prednisona a dosis de 7,5-10 mg/día (37).…”

Section: Reducción De La Inmunosupresiónunclassified

“…En pacientes con enfermedad avanzada y un órgano del que no dependa la vida, una opción es la resección del mismo y el retiro de la inmunosupresión, particularmente si no tolera la quimioterapia o el órgano está fallando por otra causa. Es difícil determinar el papel de la radioterapia como tratamiento de primera línea; se la puede considerar como parte del tratamiento en la enfermedad localizada, pero en la más avanzada no es apropiada sola o en combinación con rituximab, aunque se puede usar en pacientes no candidatos a quimioterapia o como tratamiento paliativo (28).…”

Section: Terapia Localunclassified

See 2 more Smart Citations

Enfermedad linfoproliferativa postrasplante de órgano sólido

Nieto-Ríos

Ríos

Higuita

et al. 2016

iatreia

View full text Add to dashboard Cite

RESUMENCon la denominación enfermedad linfoproliferativa postrasplante (ELPT) se conoce un grupo de trastornos que se pueden presentar con posterioridad al trasplante de órganos sólidos, con incidencia variable dependiendo del tipo de órgano trasplantado. La presentación clínica inespecífica de esta enfermedad, el compromiso extranodal y su amplio espectro histopatológico hacen que tanto la clasificación como el tratamiento sean complejos. Esta revisión presenta una actualización sobre la ELPT en pacientes con trasplante de órgano sólido. PALABRAS CLAVE Infecciones por Virus de Epstein-Barr; Trasplante de Órganos; Trastornos Linfoproliferativos SUMMARY Post-transplant lymphoproliferative diseasePost-transplant lymphoproliferative disease (PTLD) is a group of disorders that may occur after transplantation. Its incidence is variable according to the transplanted organ. The clinical variability of this disease, its extra-nodal involvement and its broad histopathological spectrum make both classification and management very complex. This review provides an update about PTLD in patients with solid organ transplantation.

show abstract

Section: Estudio Sugerido Para Los Pacientes Con Sospecha De Elptunclassified

Section: Reducción De La Inmunosupresiónunclassified

Section: Terapia Localunclassified

See 1 more Smart Citation

Enfermedad linfoproliferativa postrasplante de órgano sólido

Nieto-Ríos

Ríos

Higuita

et al. 2016

iatreia

View full text Add to dashboard Cite

show abstract

“…There are only seven other case reports of a subsequent extranodal EBV lymphoma developing in the setting of an angioimmunoblastic T cell lymphoma [14]. The patient was managed like a post transplant lymphoproliferative disorder with discontinuation of immunosuppression (vorinostat) followed by rituximab monotherapy [15]. She has since achieved a complete remission (Fig.…”

mentioning

confidence: 99%

Secondary Epstein‐Barr virus associated lymphoproliferative disorder developing in a patient with angioimmunoblastic T cell lymphoma on vorinostat

et al. 2012

View full text Add to dashboard Cite

Ebstein-Barr Virus (EBV)-related lymphoproliferative disorders primarily occur in the setting of immunosuppression, most commonly after solid organ transplantation [1]. The frequency depends on the degree of immunosuppression and the specific organ transplanted, but can be as high as 3-9% in heart or lung transplant patients [2]. Less frequent outside of the transplant setting, EBV-related lymphoproliferative disorders classified as other iatrogenic immunodeficiency associated lymphoproliferative disorders in the WHO Classification, which are different than iatrogenically related lymphomas supervening on hematological malignancies, have been associated with other immunosuppressive therapies such as 6-Mercaptopurine, azathioprine, or alemtuzumab [3][4][5][6]. These disorders have also been reported to develop spontaneously in patients with T cell lymphomas (angioimmunoblastic and peripheral T cell NOS) [7]. Here we report the case of a patient with an angioimmunoblastic T cell lymphoma on therapy with vorinostat who developed an EBV related B-cell lymphoproliferative disorder involving bilateral adrenal glands. Angioimmunoblastic T cell lymphoma is associated with severe immunodeficiency and risk for opportunistic infections [7]. This immune dysregulation has been implicated in its association with EBV related lymphoproliferative disorders [8]. In this patient, vorinostat therapy also appears to be linked to the development of an EBV-related lymphoproliferative disorder.A 59-year-old female presented two years ago with unexplained skin nodules and palpable lymphadenopathy. An excisional lymph node biopsy demonstrated T cells with moderately abundant pale cytoplasm that were positive for CD3, CD4, CD5, as well as C10 and CD279. Also present were CD20 positive B cells and immunoblasts with a mild increase in EBV positive lymphocytes. These features including a positive T cell gene rearrangement were consistent with a diagnosis of angioimmunoblastic T cell lymphoma. On a PET scan there were enlarged and FDG avid axillary, subpectoral and femoral lymph nodes. Bone marrow biopsy and aspirate were negative for lymphoma involvement.She received six cycles of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). PET imaging after the second and fourth cycles demonstrated a complete remission. The patient subsequently underwent an autologous stem cell transplant with BEAM conditioning in first remission. She tolerated this without complications. Follow-up examinations and imaging confirmed complete remission for fourteen months.The patient subsequently developed eosinophilia with eosinophilic dermatitis. PET imaging demonstrated multiple enlarged avid lymph nodes in the axillary, clavicular, hilar, porta hepatitis, peri-aortic, and inguinal region. An axillary lymph node biopsy confirmed recurrent angioimmunoblastic T cell lymphoma. She was treated with 400 mg daily of vorinostat. Interval PET scan after 2 months showed partial response. After five months of therapy her repeat PET imaging showed ...

show abstract

“…9 Early recognition of PTLD allows earlier implementation of therapeutic strategies based on reducing immunosuppression. 10 CNS PTLD may be the only manifestation of the malignancy. Therefore, in patients presenting with CNS symptoms post-transplant, PTLD should be considered in the differential diagnosis.…”

mentioning

confidence: 99%

Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus

et al. 2012

View full text Add to dashboard Cite

Post-transplant lymphoproliferative disorder (PTLD) occurs in 1 -10% of patients undergoing solid-organ transplantation and presents predominantly in the first year. It is a heterogeneous entity and encompasses indolent B-or T-cell lymphoproliferation to aggressive monomorphic lymphoma. Sirolimus is an inhibitor of the response to interleukin-2 and blocks T-and B-cell activation. The drug has been used to treat renal transplant-related PTLD, but cases of PTLD related to stopping sirolimus have not been reported. We present a case of rapidly progressive central nervous system (CNS) PTLD 11 years after transplantation, in which sirolimus had been stopped 1 month prior to symptom onset. Case reportThe patient was a 31-year-old man who had undergone cadaveric renal transplantation 9 years previously for end-stage renal failure of undetermined cause. He presented with ataxia and acute confusion. In the 3 months preceding presentation he had experienced unexplained, asymptomatic weight loss.Clinical examination was unremarkable. Sirolimus had been stopped 1 month before the onset of symptoms, owing to an apparent functional iron deficiency in the absence of evident gastro-intestinal blood loss. The patient remained on mycophenolate mofetil and prednisone.On the morning of presentation, the patient's wife witnessed his confusion and unsteadiness. He was afebrile and normotensive,

show abstract

Management of post‐transplant lymphoproliferative disorder in adult solid organ transplant recipients – BCSH and BTS Guidelines

Cited by 191 publications

References 83 publications

Enfermedad linfoproliferativa postrasplante de órgano sólido

Enfermedad linfoproliferativa postrasplante de órgano sólido

Secondary Epstein‐Barr virus associated lymphoproliferative disorder developing in a patient with angioimmunoblastic T cell lymphoma on vorinostat

Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus

Contact Info

Product

Resources

About