Incidence and clinical characteristics of posttransplant lymphoproliferative disorders: report from a single center

Muti, G.; De Gasperi, A.; Cantoni, S.; Oreste, P.; Gini, G.; Civati, G.; Busnach, G.; Brando, B.; Frigerio, M.; Mangiavacchi, M.; Alberti, A.; Decarus, L.; Rondinara, G.; De Giuli, E.; Morra, E.

In the period 1973–1998, among 2 139 allograft recipients treated with standard immunosuppression, posttransplant lymphoproliferative disorders (PTLD) developed in 19 patients (0.9 %): one plasmacytic hyperplasia, two polymorphic PTLD, one myeloma, and 15 lymphomas. PTLD developed 1 year after transplantation (tx) in 14 patients. Five patients were diagnosed at autopsy, 2 were lost to follow up, 3 died before therapy could be instituted, and 1 patient has just started chemotherapy. Of the 8 evaluable patients, 2 received acyclovir and are alive in complete remission (CR) and 6 received chemotherapy ± surgery. Of these 6, 4 died of lymphoma and/or infection, 1 died of unrelated causes in CR, and 1 is alive in CR. PTLD is a severe complication of tx, usually running an aggressive course which may preclude prompt diagnosis and treatment. Nevertheless, therapy is feasible and must be tailored on the histologic subtype. Seventy-four percent of patients were diagnosed with late-onset PTLD stressing the need for long-term follow up.