Non-Hodgkin lymphoma in renal transplantation - Six cases

Lymphoproliferative disease is a recognized complication of renal transplan tation. Non-Hodgkin lymphoma is the most common variant, more frequently of B-cell origin. They have predilection for extranodal sites and approximate ly 40% of lymphomas involve the central nervous system. The clinical presen tation is quite heterogenous, with a spectrum of histopathological findings . They have a strong and causal association with Epstein-Barr virus infecti on and immunossuppresive treatment. The optimal treatment is not clear. Fro m 1967 post-transplantation lymphoproliferative disorders were diagnosed in 6 renal transplant recipients (0.95%) from 10 months to 18 years after tra nsplant. Azathioprine and prednisone were utilized in all of the patients, and two of them received cyclosporin. A in addition to these drugs. Almost all lymphomas presented in extranodal sites and 4 patients had neurologic s ymptoms, but the central nervous infiltration was demonstrated in only two cases. All of them were high-grade lymphomas and 2 were of T-cell origin. N o Epstein-Barr virus hybridation studies were made. Immunossupresive treatm ent consisted of azathioprine and prednisone and two patients received cycl osporin in addition. Three patients were treated with chemotherapy in combi nation with radiotherapy in a cutaneous T-cell lymphoma. The only survivor had a cutaneous lymphoma.