M. Mccarthy et al., THE CLINICAL DIVERSITY AND ROLE OF CHEMOTHERAPY IN LYMPHOPROLIFERATIVE DISORDER IN LIVER-TRANSPLANT RECIPIENTS, Journal of hepatology, 27(6), 1997, pp. 1015-1021
Background/Aims: Post-transplant lymphoproliferative disorder is a wel
l-documented complication with an incidence ranging from 2 to 10%, dep
ending on the organ transplanted. Yet despite our increased understand
ing of the pathophysiology of this disease and the various treatments
available, the mortality remains high at 60-80%. We present the clinic
al and histological features of ten adult liver transplant recipients
with post-transplant lymphoproliferative disorder presenting over a 15
-year period and review the therapeutic options. Methods: CD20/CD45RO
immunostaining was used for T/B-cell markers; polymerase chain reactio
n and is-sits hybridisation for Epstein-Barr virus genome detection; k
appa/lambda, immunostaining and gene rearrangement analysis for clonal
ity. Results: There mere six females and four males (age range 24-56)
with onset of post-transplant lymphoproliferative disorder-symptoms ra
nging from 3 to 72 months post transplant. Sites of post-transplant ly
mphoproliferative disorder included liver (n=4), lymph nodes (n=5), bo
ne marrow (n=2), lungs (n=2), kidneys (n=2), brain, ovaries,: and panc
reas (n=1), All lesions were classified as high-grade lymphoma, of B-c
ell lineage (9 tested); Epstein-Barr virus genome was detected in 7/10
cases. Three tumours were monoclonal; four were polyclonal and three
undetermined. Treatment included immunosuppression reduction, antivira
l therapy with acyclovir and/or chemotherapy (CHOP or VAPEC-B). Surviv
al times for those patients not treated with chemotherapy mere from 9
days to 30 months, whereas those receiving chemotherapy had remission
times of 4 to 48 months. Conclusions: Longer-term remissions can be ac
hieved in patients treated with systemic chemotherapy, although not wi
thout morbidity. Clonality assessment is important but treatment decis
ions should be based primarily on clinical features of progression, as
polyclonal tumours can behave as aggressively as monoclonal tumours.