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Morphologic bone marrow changes in patients with posttransplantation lymphoproliferative disorders
H Koeppen1, K Newell, D A Baunoch
1Department of Pathology, University of Chicago, Illinois 60637, USA.
The American Journal of Surgical Pathology
|March 21, 1998
Summary
Bone marrow biopsies reveal significant morphologic changes in 54% of patients with posttransplantation lymphoproliferative disorders (PTLPD). Epstein-Barr virus (EBV) was detected in most cases with bone marrow changes, particularly in younger patients.
Area of Science:
- Transplant medicine
- Hematopathology
- Oncology
Background:
- Posttransplantation lymphoproliferative disorders (PTLPD) are a serious complication following organ transplantation.
- Bone marrow biopsies are a common diagnostic tool, but the specific morphologic changes in PTLPD are not well-characterized.
- Understanding bone marrow involvement is crucial for accurate diagnosis and management of PTLPD.
Purpose of the Study:
- To define the spectrum of morphologic bone marrow changes in patients with posttransplantation lymphoproliferative disorders (PTLPD).
- To investigate the association of Epstein-Barr virus (EBV) with bone marrow morphologic changes in PTLPD.
- To compare the incidence of bone marrow changes in pediatric versus adult patients with PTLPD.
Main Methods:
- Retrospective analysis of bone marrow biopsy samples from 26 transplant patients with PTLPD and 20 control transplant patients without PTLPD.
- Morphologic evaluation of bone marrow biopsy specimens.
- Detection of Epstein-Barr virus-encoded small transcripts (EBER) using in situ hybridization.
Main Results:
- Morphologic bone marrow changes were identified in 54% of patients with PTLPD.
- These changes included aggregates of lymphoid and plasma cells with variable features.
- Epstein-Barr virus-encoded small transcripts (EBER) were detected in 9 of 13 bone marrow samples with morphologic changes.
- Bone marrow changes were significantly more frequent in pediatric patients (76%) compared to adult patients (11%).
- No statistically significant difference in mortality was observed between patients with and without bone marrow changes, likely due to sample size.
Conclusions:
- Bone marrow morphologic changes are a frequent finding in patients with posttransplantation lymphoproliferative disorders (PTLPD).
- The presence of Epstein-Barr virus (EBV) is associated with these bone marrow changes.
- The higher incidence of bone marrow changes in pediatric PTLPD suggests distinct pathogenetic mechanisms compared to adults, potentially involving EBV.