[Lymphoproliferative disease after transplantation].

Area of Science:

• Immunology
• Oncology
• Transplantation Medicine

Context:

• Posttransplantation lymphoproliferative disease (PTLD) is a serious complication following solid organ and hematopoietic stem cell transplantation.
• PTLD arises from the proliferation of lymphoid cells, often associated with Epstein-Barr virus (EBV) infection.
• Understanding PTLD pathogenesis and clinical course is crucial for improving patient outcomes.

Purpose:

• To report on 7 cases of PTLD, detailing their clinical characteristics, diagnostic findings, and treatment outcomes.
• To investigate the association of PTLD with EBV and specific PTLD subtypes (monomorphic and polymorphic).
• To evaluate the efficacy of current treatment strategies, including immunosuppression reduction, chemotherapy, and surgery.

Summary:

• Seven PTLD cases (kidney, kidney-pancreas, heart, stem cell recipients) aged 25-62 were analyzed, occurring 4 months to 12 years post-transplant.
• Cases included monomorphic (4) and polymorphic (3) PTLD, with EBV detected in some via immunohistochemistry and PCR.
• Monoclonal immunoglobulin heavy chain gene rearrangement was identified in three cases.
• Treatment involved immunosuppression adjustment, chemotherapy, and surgery; mortality was high, primarily due to infections.

Impact:

• This case series highlights the diverse clinical presentations and challenging prognosis of PTLD.
• Findings underscore the importance of EBV status in PTLD development and management.
• The study emphasizes the need for optimized therapeutic strategies to improve survival rates in transplant recipients with PTLD.