PULMONARY LYMPHOMA IN CARDIAC TRANSPLANT PATIENTS TREATED WITH OKT3 FOR REJECTION - DIAGNOSIS BY FINE-NEEDLE ASPIRATION

At Hines VA Hospital, three out of 38 cardiac transplant patients, who were 9, 10, and 14 mo post-surgery and treated with immunosuppressive drugs, including OKT3 prophylaxis for acute rejection, developed a so litary pulmonary nodule.Fine-needle aspiration biopsy of the nodules i n these three patients revealed a hypercellular, monotonous population of large lymphoid cells. These abnormal cells were isolated, with sma ll aggregates occasionally seen. The nuclear membranes were irregular, the chromatin was finely granular, nucleoli were prominent, and mitot ic figures were frequently noted. The cells were immunoreactive to leu kocyte common antigen and B-lymphocyte. Lambda light chain immunoglobu lin was positive in one case, kappa in the second case, and neither li ght chains in the third patient. By electron microscopy in one case, t he cells were large immature lymphoid cells with immunoblastic feature s. Subsequent tissue studies, complemented by frozen section immunosta ining, flow cytometry, and phenotyping, reaffirmed the diagnosis of ma lignant lymphoma. It appears that OKT3 therapy increases several fold the risk of lymphoma's developing in cardiac transplant patients. Prel iminary published reports have also recommended close surveillance of patients receiving OKT3 for early indications of lymphoproliferative d isorder and a reevaluation of the risk vs. benefit for the prophylatic use of OKT3. (C) 1995 Wiley-Liss, Inc.