Posttransplant t-cell lymphoma. Report of three cases and a review of the literature

Abstract

Background. Although 14% of the malignant lymphomas after organ transplantation are reported to be T‐cell lymphomas, only a few cases are described in the literature. Methods. The authors presented three new cases. They summarized the clinical data and analyzed histologic and immunochemical findings. The presence of Epstein‐Barr virus (EBV) and human T‐cell lymphoma type 1 (HTLV‐1) were investigated. T‐cell receptor (TCR) rearrangement was analyzed by Southern blot technique in two cases. Results. Two of the three lymphomas developed after renal transplantation. One was a T‐cell lymphoma of pleomorphic medium‐sized cell type and the other was a T‐cell lymphoblastic lymphoma; the third T‐cell lymphoma was an anaplastic large cell (Ki‐1 positive) type that developed after heart transplantation. No association was established with EBV or HTLV‐1. A monoclonal TCR rearrangement was found in the two cases that were analyzed. A literature search revealed 22 other cases. Nineteen of the 22 reported cases were peripheral T‐cell lymphomas. Almost all lymphomas presented in extranodal sites. The time between diagnosis and organ transplantation seemed to be influenced by the type of immunosuppressive therapy. In five cases, EBV was detected in the tumor cells. A monoclonal T‐cell receptor rearrangement was found in eight cases and a polyclonal proliferation in one case. Response to therapy was variable, but often poor. Conclusions. The etiology of posttransplant T‐cell lymphomas remains unclear. Similarities with post‐transplant B‐cell proliferations are the predominant extranodal presentation and the finding that the time of occurrence is influenced by the type of immunosuppression. In contrast with posttransplant B‐cell proliferations, only a minority of the cases are associated with EBV. Most tumors appear to be monoclonal. Prognosis is generally poor, but tumor presentation with localized disease might have a somewhat better prognosis. Cancer 1994; 73:3064–72.

EBV Positive Primary Cutaneous CD30+ Large T-Cell Lymphoma in a Heart Transplanted Patient: Case Report

“…Reduced immunosurveillance, chronic antigenic stimulation due to the graft, or a direct oncogenic effect of immunosuppressive drugs have all been suggested as possible mechanisms leading to T-cell lymphoma in transplant recipients (16).…”

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“…4 Literature review showed 7 previous patients who had T-ALL after solid organ transplant (Table 1). [7][8][9][10][11][12] There is ambiguity about the pathogenesis of T-cell posttransplant lymphoproliferative disorder, and there are no accepted diagnostic criteria. Therefore, this condition is rarely reported and inconsistently characterized.…”

Epstein–Barr virus-associated T cell lymphoproliferative disorder following autologous blood stem cell transplantation for relapsed Hodgkin's disease

“…[3][4][5] Our patient did not respond to antiviral agents, ␥-globulin, or a chemotherapeutic agent. Donor T cell infusion has been reported to be effective for treating EBV-associated B cell PTLD after allogeneic HCT.…”

“…1,2 PTLD are virtually always of B cell origin; PTLD of T cell origin is rare. [3][4][5] Also, while B cell PTLD are usually associated with Epstein-Barr virus (EBV) infection, most T cell PTLD are not associated with the EBV genome. [3][4][5] Three cases of T cell PTLD have been reported as occurring after allogeneic HCT, all unassociated with EBV infection; 3 T cell PTLD after autologous HCT has not been reported.…”