HODGKINS-DISEASE AFTER TRANSPLANTATION

Hodgkin's disease (HD) has seldom been reported after transplantation. Epstein-Barr virus (EBV) is present in about 50% of Reed-Sternberg ce lls in KD developing in immunocompetent individuals, but is more frequ ently found in HD of acquired immune deficiency syndrome patients, We report 7 cases of HD that occurred in transplant recipients. Clinical and pathological data and studies of EBV reveal specific features of H D after transplantation. Six patients received kidney transplants and 1 patient received combined kidney and pancreas transplantation, Immun osuppressive therapy consisted of cyclosporine, steroids, azathioprine , and antilymphocyte globulins, One patient received, in addition, ant i-CD3 mAb therapy and an EBV(+) B cell lymphoma developed, Retrospecti ve EBV serological data from patients were collected, Turners were cla ssified according to pathology, EBV studies were conducted by immunohi stochemical methods with monoclonal antibodies to EBV-latent membrane protein (LMP) or EBV-nuclear antigen 2 (EBNA2), and by in situ hybridi zation for latent nuclear EBV-early RNAs (EBERs). The mean lapse of ti me between transplantation and HL was 49 months, Six patients presente d with enlarged lymph nodes and 1 patient presented with liver involve ment, HD was classified as IA in 2 patients, IIA in 3 patients, IIIB i n 1 patient, and IVB in 1 patient. Four patients had primary EBV infec tion after graft, before HD, and the others reactivated latent EBV inf ection, Histological subtypes were mixed cellularity in 6 cases and ly mphocytic depletion in 1 case, Latent EBV infection was detected with EBERs in all tumors, Reed-Sternberg cells expressed LMP, and were nega tive for EBNA2 expression, Six patients were treated: 2 patients at st age I received radiotherapy, and relapsed within 1 year with a more ad vanced stage of HD; chemotherapy was indicated as primary therapy in 5 patients, and as salvage therapy in 2 patients; it was associated wit h radiotherapy in 4 patients, Immunosuppressive therapy was reduced in all patients, Four patients were alive and in complete remission 18, 25, 31, and 67 months after chemotherapy, with a functioning graft in 3 patients. Two patients died of infection. Mixed cellularity is the m ost frequent histological subtype observed in HD occurring in transpla nt patients, EBV is present in all Reed-Sternberg cells, Posttransplan t HD shows similarities with human immunodeficiency virus-associated H D. These facts argue for a role of EBV infection and immunosuppression in the progression of HD after transplantation.