Posttransplantation plasma cell dyscrasias

Area of Science:

• Oncology
• Immunology
• Transplantation Medicine

Background:

• Post-transplant lymphoproliferative disorders (PTLD) are typically B-cell neoplasms linked to Epstein-Barr virus (EBV) in immunosuppressed organ transplant recipients.
• While some PTLDs show plasmacytoid features, terminal differentiation into plasma cells secreting monoclonal immunoglobulin is uncommon.
• This report details a liver transplant patient who developed EBV-positive abdominal and bladder plasmacytomas with a significant monoclonal immunoglobulin G kappa paraprotein.

Observation:

• The patient presented with multiple plasmacytomas and elevated levels of a specific monoclonal immunoglobulin.
• Epstein-Barr virus (EBV) genomes and RNA transcripts were detected in the plasmacytomas.
• Clonally restricted kappa light chain expression was observed, but EBV latent membrane protein 1 was not detected, and H-ras gene mutations were absent.

Findings:

• Epstein-Barr virus (EBV) genomes and EBER-1 transcripts confirmed EBV presence in the plasmacytomas.
• Immunohistochemistry revealed clonal kappa light chain restriction, indicating a monoclonal plasma cell proliferation.
• No codon-12 mutations in the H-ras gene were identified in the tumor cells.

Implications:

• The successful resolution of plasmacytomas and paraprotein levels following radiation and reduced immunosuppression suggests a favorable prognosis.
• Terminal plasmacytic differentiation in EBV-associated PTLD does not inherently indicate a poor outcome.
• This case highlights the potential for successful management of rare, differentiated PTLDs in transplant patients.