scholarly journals Post-transplant Lymphoproliferative Disorders: Single Center Case Series and Literature Review

2020 ◽  
pp. 1-6
Author(s):  
Sumayyah Altamimi ◽  
◽  
Mohamed Al Shuaibi ◽  
Mohamed Alnahdi ◽  
Abdulrahman Altheaby ◽  
...  
Keyword(s):  
De Novo ◽  
Organ Transplant ◽  
Tumor Development ◽  
Case Series ◽  
Standard Of Care ◽  
Lymphoproliferative Disorders ◽  
Outcome Analysis ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Post Transplant

Post-transplant lymphoproliferative disorders (PTLD) are referred to lymphoid and/or plasmacytic proliferation which occur as result of immunosuppression therapy in patient underwent solid organ or allogeneic hematopoietic stem cell transplantation. Among solid organ transplant recipients, it accounts approximately 20% of all cancers. Epstein-Barr virus (EBV) has been linked to the pathogenesis of PTLD when EBV was identified in the tumor biopsies. In most affected patients, PTLD occurs as a result of proliferation of EBV positive B cell following immunosuppression and impaired Tcell immune activity. EBV negative PTLD has been documented but no clear etiology has been confirmed, however theories of previous exposure to EBV which is completely cleared at the time of PTLD is diagnosed, different viruses or chronic antigenic stimulation all been considered as provoking factors for tumor development. Clinical symptomatology at presentation of patients with PTLD is usually indistinct from de novo lymphoproliferative disorders and chemotherapy protocols in this group of patients are generally similar to the standard of care of lymphoma treatment according to the subtype in addition to cessation or dose reduction of immunosuppressive therapy. We report our experience and outcome analysis in PTLD management among 23 patients from our institution treated between 2011 and 2019.

Morphologic Evolution in Post-Transplant Lymphoproliferative Disorders (PTLD): A Clinicopathologic Case Series

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5008-5008
Author(s):  
Ryan J. Stubbins ◽  
Anthea C Peters ◽  
Mabilang Curtis ◽  
Carolyn Owen ◽  
Adnan Mansoor ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Organ Transplant ◽  
Case Series ◽  
Pulmonary Involvement ◽  
Extramedullary Plasmacytoma ◽  
Lymphoproliferative Disorders ◽  
Hodgkin's Lymphoma ◽  
Solid Organ ◽  
Post Transplant ◽  
Common Precursor

Abstract Post-transplant lymphoproliferative disorders (PTLDs) are classified as early PTLDs (E-PTLD), polymorphic PTLDs (P-PTLD), monomorphic PTLDs (M-PTLD) and classical Hodgkin's Lymphoma PTLD (HL). These entities are felt to represent a disease continuum, with a precursor-product relationship, though they are morphologically and clinically distinct. However, this process remains poorly understood, and limited evidence exists to support this hypothesis. We report a series of nine cases extracted from a PTLD database, including both pediatric and adult solid organ transplant recipients, with recurrent disease episodes that evince an apparent evolution in their morphologic categorization between episodes. All patients identified were high risk for PTLD, with multiple identifiable predisposing factors. Presentations varied from isolated lymphadenopathy, to gastrointestinal involvement to pulmonary involvement. Four of the patients were deceased at the time of acquisition, though only one directly from PTLD. Eight of the nine identified patients developed E or P-PTLD lesions that preceded a subsequent M-PTLD or HL lesion at a similar tissue site. Two of the cases had metachronous P and M-PTLD lesions. The six M-PTLD subtypes were variable, including DLBCL, Burkitt, T-cell, and extramedullary plasmacytoma, in addition to the three cases of classical Hodgkin's lymphoma. These cases suggest that E and P-PTLD may act as common precursor lesions to the development of both the M-PTLD variants and HL type lesions, and that the PTLD classification schema represents different stages of a common underlying pathology. Disclosures Owen: Lundbeck: Honoraria; Gilead: Honoraria; Janssen: Honoraria; Roche: Honoraria.

scholarly journals 1394. Clinicopathologic Features of Infectious and Noninfectious Tissue Granulomas in Transplant Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S506-S507
Author(s):  
Eliezer Zachary Nussbaum ◽  
Rita Abi Raad ◽  
Maricar Malinis ◽  
Marwan M Azar
Keyword(s):  
Risk Factors ◽  
Organ Transplant ◽  
Severe Infection ◽  
Adverse Outcomes ◽  
Solid Organ ◽  
Cell Transplant ◽  
Clinicopathologic Features ◽  
Hematopoietic Stem ◽  
Cryptogenic Organizing Pneumonia ◽  
Post Transplant

Abstract Background There is a paucity of literature about the implications of granulomatous disease in hematopoietic stem cell transplant (HSCT) and solid-organ transplant (SOT) patients. Given the broad range of infectious and noninfectious etiologies as well as the heightened risk for severe infection, it is important to characterize the clinicopathologic features of granulomas in this population and to develop a framework to guide further evaluation. Methods We performed chart reviews of 1,280 transplant recipients (791 SOT and 489 HSCT) at Yale-New Haven Hospital from 2009 to 2019 to identify patients with granulomas in pathologic specimens obtained peri-transplantation. Data on histopathology, microbiology, indication for biopsy, patient characteristics, and clinical presentation were recorded. Morbidity and mortality were noted at 1, 3, and 12 months after granuloma diagnosis. Results We identified 28 patients with granulomas (9 SOT, 19 HSCT); an incidence of 2.2%. None had explicit risk factors for MTB. Most granulomas (93%) were non-necrotizing. Common sources were lung (n = 9) and lymph node (n = 5). Most were found post-transplant (n = 19) and biopsies were prompted mostly by symptoms (n = 13) or incidental imaging findings (n = 9). Most granulomas were not associated with an infectious process (n = 20). Among infectious granulomas, bacterial soft-tissue infection (n = 2), bartonellosis (n = 2), and fungal infection (1 Cryptococcus and 1 Blastomyces) were most common. MTB PCR was negative in 4 specimens. Among granulomas discovered in SOT patients, 44% were infectious compared with 21% in HSCT recipients. Most infectious granulomas were found in symptomatic patients (75%). One granuloma-related adverse outcome occurred in a case of cryptogenic organizing pneumonia discovered pre-HSCT that worsened with tapering of immunosuppression post-HSCT. Conclusion Granulomas were uncommon in a large transplant population. Most were deemed noninfectious and their presence alone was not associated with adverse outcomes post-transplant or with increased immunosuppression. Granulomas were more likely to be infectious in SOT recipients and those with symptoms. Symptoms should guide the extent of microbiologic evaluation and reflexive MTB PCR testing is not warranted if risk factors are absent. Disclosures All authors: No reported disclosures.

scholarly journals Use of Post-transplant Cyclophosphamide Treatment to Build a Tolerance Platform to Prevent Liquid and Solid Organ Allograft Rejection

2021 ◽  
Vol 12 ◽  
Author(s):  
Casey O. Lightbourn ◽  
Dietlinde Wolf ◽  
Sabrina N. Copsel ◽  
Ying Wang ◽  
Brent J. Pfeiffer ◽  
...  
Keyword(s):  
Corneal Transplantation ◽  
Organ Transplant ◽  
Tolerance Induction ◽  
Solid Organ ◽  
Corneal Tissue ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Cyclophosphamide Treatment ◽  
Immunological Rejection

Corneal transplantation (CT) is the most frequent type of solid organ transplant (SOT) performed worldwide. Unfortunately, immunological rejection is the primary cause of graft failure for CT and therefore advances in immune regulation to induce tolerance remains an unmet medical need. Recently, our work and others in pre-clinical studies found that cyclophosphamide (Cy) administered after (“post-transplant,” PTCy) hematopoietic stem cell transplantation (HSCT), i.e., liquid transplants is effective for graft vs. host disease prophylaxis and enhances overall survival. Importantly, within the past 10 years, PTCy has been widely adopted for clinical HSCT and the results at many centers have been extremely encouraging. The present studies found that Cy can be effectively employed to prolong the survival of SOT, specifically mouse corneal allografts. The results demonstrated that the timing of PTCy administration is critical for these CT and distinct from the kinetics employed following allogeneic HSCT. PTCy was observed to interfere with neovascularization, a process critically associated with immune rejection of corneal tissue that ensues following the loss of ocular “immune privilege.” PTCy has the potential to delete or directly suppress allo-reactive T cells and treatment here was shown to diminish T cell rejection responses. These PTCy doses were observed to spare significant levels of CD4+ FoxP3+ (Tregs) which were found to be functional and could readily receive stimulating signals leading to their in vivo expansion via TNFRSF25 and CD25 agonists. In total, we posit future studies can take advantage of Cy based platforms to generate combinatorial strategies for long-term tolerance induction.

Sign in / Sign up

Export Citation Format

Share Document