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Posttransplant T-cell lymphoproliferative disorders--an aggressive, late
complication of solid-organ transplantation
MN Hanson, VA Morrison, BA Peterson, KT Stieglbauer, VL Kubic, SR McCormick, RC McGlennen, JC Manivel, RD Brunning and CE Litz
Department of Laboratory Medicine, University of Minnesota Hospital and
Clinic, Minneapolis, USA.
T-cell non-Hodgkin's lymphomas are an uncommon occurrence after solid-
organ transplantation. We describe a morphologically and
immunophenotypically distinct group of T-cell lymphoproliferative disorders
that occurred late in the course of six patients with solid- organ
transplants. The patients ranged in age from 31 to 56 years (median, 43).
Three were male; all were splenectomized. The interval from transplant to
the diagnosis of lymphoma ranged from 4 to 26 years (median, 15). Symptoms
at presentation were related to sites of involvement. Pulmonary, marrow,
and CNS involvement were present in five, four, and one case, respectively.
No patient had lymphadenopathy. Five patients had an elevated lactate
dehydrogenase level (range, 226 to 4,880 IU/L; median, 1,220 IU/L). Five of
six patients had a leukoerythroblastic reaction. All cases had large-cell
histology and frequently contained cytoplasmic granules. Those cases tested
expressed CD2, CD3, and CD8 and were negative for B-cell antigens. T-cell
receptor beta- and gamma-chain genes were clonally rearranged in three of
three and one of three cases, respectively. All T-cell posttransplant
lymphoproliferative disorders (T-PTLDs) studied were negative for
Epstein-Barr virus (EBV), human T-cell leukemia/lymphoma virus type 1
(HTLV-1), human T-cell leukemia/lymphoma virus type 2 (HTLV-2), and human
herpes virus type 8 (HHV-8) genomes. Treatment with acyclovir (three
patients) or chemotherapy (three patients) resulted in two responses. All
patients had an aggressive course, with a median survival duration of 5
weeks. In conclusion, a clinically aggressive T- PTLD may be a late
complication of solid-organ transplantation and does not appear to be
related to EBV, HTLV-1, HTLV-2, or HHV-8 infection.
Volume 88,
Issue 9,
pp. 3626-3633,
11/01/1996
Copyright © 1996 by The American Society of Hematology
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