A Case Report of Posttransplant Lymphoproliferative Disorders Successfully Treated with R-CHOP in Korea

Sul Hee Yoon; Soo Jeong Kim; Hye Won Lee; Doh Yu Hwang; Jin Seok Kim; June-Won Cheong; Yoo Hong Min

doi:10.5045/kjh.2008.43.2.106

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Yoon, Kim, Lee, Hwang, Kim, Cheong, and Min: A Case Report of Posttransplant Lymphoproliferative Disorders Successfully Treated with R-CHOP in Korea

Case Report

Korean J Hematol 2008;43(2):106-112.

Published online: 19 June 2008

DOI: https://doi.org/10.5045/kjh.2008.43.2.106

A Case Report of Posttransplant Lymphoproliferative Disorders Successfully Treated with R-CHOP in Korea

Sul Hee Yoon, M.D., Soo Jeong Kim, M.D., Hye Won Lee, M.D., Doh Yu Hwang, M.D., Jin Seok Kim, M.D., Ph.D., June-Won Cheong, M.D., Ph.D., Yoo Hong Min, M.D., Ph.D.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Correspondence to：Yoo Hong Min, M.D., Ph.D. Department of Internal Medicine, Yonsei University College of Medicine 134, Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: ＋82-2-2228-1956, Fax: ＋82-2-393-6884 E-mail: minbrmmd@yumc.yonsei.ac.kr

Received 9 October 2007 Revised 14 May 2008 Accepted 20 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is a group of heterogeneous lymphoid diseases that cause serious complications after organ or stem cell transplantation. The onset of PTLD is mostly due to EBV infection-induced B-cell proliferation and a defect in cytotoxic T cell function that occurs with immunosuppression. The usual treatment strategy for PTLD is reduction or withdrawal of immunosuppressive drugs with or without the administration of antiviral agents. Recently, various studies on the efficacy of rituximab or chemotherapy have been reported. We report two cases of rapidly progressing and complicated PTLDs after kidney transplantation that were successfully treated with a combination regimen consisting of rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone (R-CHOP).

Keywords: Posttransplant, Lymphoproliferative, R-CHOP

REFERENCES

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Fig. 1

A large chest wall mass show increased FDG uptake and consistent with lymphoma involvement.

Fig. 2

Increased FDG uptake at the T4 body, suggest lymphoma involvement.

Fig. 3

Multiple splenic and pancreas masses, and LNs in left gastric celiac trunk and paraaortic area, consistent with lymphoma involvement.

Fig. 4

Complete loss of multiple splenic and pancreas masses previously noticed after chemotherapy. No evidence of recurrence.

Table 1.

Summary of cases with post-transplant lymphoproliferative disease reported in Korea

Reference	Sex/Age	Organtransplanted	Onset(day)	Acute rejection	Immunosuppressant agents	Sites of PTLD	Pathology	EBV	Tx	Outcomes
Kim et al.⁵⁾	M/33	Kidney	150	N	CSA, PL, AZA	Submandibular gl.	Polymorphic B-cell lineage large cell immunoblastic type	+	Surgery, RI, RTx	CR
Park et al.⁶⁾	F/33	Liver	NA	Y	CSA, PL, AZA, FK506	Liver, smallintestine, LN	Polymorphous proliferation of NAB lymphoid cells	NA	No Tx(autopsy)	NA
Park et al.⁶⁾	M/56	Liver	120	Y	CSA, PL, AZA	Liver	PTLD	+	RI	Death^†
Choi et al.⁷⁾	F/58	Kidney	150	Y	CSA, PL, AZA	Maxillary sinus, LN	DLBCL	+	BACOP x2	Death
	M/67	Kidney	2,370	N	CSA, PL	LN, lung	Burkitt type small	−	CHOP x2	Death
	M/37	Kidney	2,430	Y	CSA, PL, AZA	Liver, peritoneum	PTLD	+	No Tx	Death
	M/27	Kidney	240	Y	CSA, PL, MMF	T-spine	DLBCL	+	Surgery, RTx, CTx	CR
Lee et al.⁸⁾	M/33	Kidney	2,700	N	CSA, PL, AZA, MMF	LN	DLBCL	+	RI, CTx	Death
	F/41	Kidney	2,790	N	CSA, PL, AZA, MMF	LN	DLBCL	−	RI, CTx	CR
	M/45	Kidney	3,090∗	N	CSA, PL, AZA, MMF	LN, liver, spleen, graft	DLBCL	+	RI, ACV→R+CTx	Death
Jang et al.⁹⁾	M/42	Heart, lung	180	N	CSA, PL, AZA	Lung	PTLD	+	No Tx	Death
Jang et al.⁹⁾	F/36	Lung	730	N	NA	Lung	PTLD	NA	CTx	Death
Park et al.¹⁰⁾	M/46	Kidney	3,285	Y	CSA, PL	Liver, LN, graft	DLBCL	+	CHOP x1→R x4	CR
Kim et al.¹¹⁾	M/34	Kidney	900	N	CSA, PL, AZA	Stomach, heart,mesenteric LN	NK/T-cell lymphoma	NA	No Tx	Death
Choi et al.¹²⁾	M/58	Liver	60	N	CSA, FK506	LN	B-cell lymphoma, CD20(+)	+	RI, ACV, CTx	CR
Byun et al.¹³⁾	M/44	Kidney	3,240	Y	CSA, PL, AZA, FK506	LN, spleen	DLBCL	+	RI+CHOP x6	CR
Park et al.¹⁴⁾	M/37	HSCT	83		CSA+MTX, PL, ATG	Stomach	Polymorphic PTLD	+	RI, ACV, DLI	CR
	M/27	HSCT	244		CSA+MTX, PL	Colon	Polymorphic PTLD	−	RI, ACV, DLI	CR
	M/44	HSCT	87		CSA+MTX	LN, oropharynx	DLBCL	−	RI, DLI	CR
	M/17	HSCT	244		FK506+MTX, PL	LN	Plasmacytic hyperplasia	+	RI, ACV	CR
	M/45	HSCT	1,534		CSA+MTX, PL	LN, tonsil, lung	Polymorphic PTLD	+	RI, ACV	PR
	F/43	HSCT	1,907		CSA+MTX, PL	LN	DLBCL	NA	RI, DLI	SD
	M/23	HSCT	1,985		ATG	LN, lung, liver/splee	nT-cell lymphoma	+	RI	Death^†

∗Polyclonal disease onset (Onset of monoclonal disease is 3330 days)

^†Death due to PTLD progression. Abbreviations: PTLD, post-transplant lymphoproliferative disease; HSCT, hematopoietic stem cell transplantation; NA, data not available; CSA, cyclosporine; PL, prednisolone; MTX, methotrexate; MMF, micophenolate mofetil; ATG, antithymocyte immunoglobulin; LN, lymph node; DLBCL, diffuse large B-cell lymphoma; RI, reductionof immunosuppressant agents; RTx, radiotherapy; CTx, chemotherapy; ACV, acyclovir; DLI, donor lymphocyte infusion; CR, complete remission; PR, partial remission;SD, stable disease; AZA, azathioprine.

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