Posttransplant Lymphoproliferative Disease in Children: Correlation of Histology to Clinical Behavior

Hayashi, Robert J.; Kraus, Madeleine D.; Patel, Aloka L.; Canter, Charles E.; Cohen, Alan H.; Hmiel, Paul; Howard, Todd K.; Huddleston, Charles B.; Lowell, Jeffrey A.; Mallory, George B.; Mendeloff, Eric N.; Molleston, Jean P.; Sweet, Stuart C.; DeBaun, Michael R.

doi:10.1097/00043426-200101000-00005

Cited by 75 publications

(50 citation statements)

References 14 publications

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“…Although we could not assess the role of pretransplant EBV serology, our observation that posttransplant EBV infection/reactivation only occurred in those who subsequently developed NHL, supports an important role of EBV in the development of early posttransplant NHL. In line with this, early-onset NHL/PTLD (occurring within 12 months) is typically EBV positive (27)(28)(29). Growth and/or apoptosis-controlling cellular pathways are disturbed by the action of EBV viral proteins (EBNA-1 and LMP-1), resulting in complete immortalization of B cells (30,31).…”

Section: Discussionmentioning

confidence: 89%

Time Trends in Risk and Risk Determinants of Non-Hodgkin Lymphoma in Solid Organ Transplant Recipients

Fernberg

Edgren

Adami

et al. 2011

American Journal of Transplantation

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Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.

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Section: Discussionmentioning

confidence: 89%

Time Trends in Risk and Risk Determinants of Non-Hodgkin Lymphoma in Solid Organ Transplant Recipients

Fernberg

Edgren

Adami

et al. 2011

American Journal of Transplantation

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“…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%

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

972

787

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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.

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“…[15][16][17][18] Diagnosis and grading of AR was performed at each individual center without a central pathology review. Post-transplant lymphoproliferative disease (PTLD) was diagnosed by histologic examination of tissue biopsy [19].…”

Section: Other Post Transplant Outcomesmentioning

confidence: 99%

502: CMVIG Decreases the Risk of Cytomegalovirus Infection but Not Disease after Pediatric Lung Transplantation

Danziger‐Isakov

Michaels

Ranganathan

et al. 2009

The Journal of Heart and Lung Transplantation

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Posttransplant Lymphoproliferative Disease in Children: Correlation of Histology to Clinical Behavior

Cited by 75 publications

References 14 publications

Time Trends in Risk and Risk Determinants of Non-Hodgkin Lymphoma in Solid Organ Transplant Recipients

Time Trends in Risk and Risk Determinants of Non-Hodgkin Lymphoma in Solid Organ Transplant Recipients

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

502: CMVIG Decreases the Risk of Cytomegalovirus Infection but Not Disease after Pediatric Lung Transplantation

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