POSTTRANSPLANT T-CELL LYMPHOPROLIFERATIVE DISORDERS - AN AGGRESSIVE, LATE COMPLICATION OF SOLID-ORGAN TRANSPLANTATION

T-cell non-Hodgkin's lymphomas are an uncommon occurrence after solid- organ transplantation. We describe a morphologically and immunophenoty pically distinct group of T-cell lymphoproliferative disorders that oc curred late in the course of six patients with solid-organ transplants . The patients ranged in age from 31 to 56 years (median, 43). Three w ere male; all were splenectomized. The interval from transplant to the diagnosis of lymphoma ranged from 4 to 26 years (median, 15). Symptom s at presentation were related to sites of involvement. Pulmonary, mar row, and CNS involvement were present in five, four, and one case, res pectively, No patient had lymphadenopathy. Five patients had an elevat ed lactate dehydrogenase level (range, 226 to 4,880 IU/L: median, 1,22 0 IU/L). Five of six patients had a leukoerythroblastic reaction. All cases had large-cell histology and frequently contained cytoplasmic gr anules. Those cases tested expressed CD2, CD3, and CD8 and were negati ve for B-cell antigens. T-cell receptor beta- and gamma-chain genes we re clonally rearranged in three of three and one of three cases, respe ctively, All T-cell posttransplant lymphoproliferative disorders (T-PT LDs) studied were negative for Epstein-Barr virus (EBV), human T-cell leukemia/lymphoma virus type 1 (HTLV-1), human T-cell leukemia/lymphom a virus type 2 (HTLV-2), and human herpes virus type 8 (HHV-8) genomes . Treatment with acyclovir (three patients) or chemotherapy (three pat ients) resulted in two responses. All patients had an aggressive cours e, with a median survival duration of 5 weeks. In conclusion, a clinic ally aggressive T-PTLD may be a late complication of solid-organ trans plantation and does not appear to be related to EBV, HTLV 1, HTLV-2, o r HHV-8 infection. (C) 1996 by The American Society of Hematology.