Durable remission after aggressive chemotherapy for very late post-kidney transplant lymphoproliferation: A report of 16 cases observed in a single center

Purpose: Posttransplant lymphoprolifeative diseases (PTLDs) represent a gro up of potentially lethal lymphoid proliferations that may complicate the co urse of solid organ transplantation. Although early-onset PTLDs frequently have ct favorable outcome, late-onset PTLDs behave more alike aggressive ly mphoma. We report a monocentric retrospective study that focused on PTLDs o ccurring later than 1 year after kidney transplantation (very late-onset PT LDs) to define their incidence, clinical presentation, pathologic features, and outcome. We particularly emphasized the follow-up of patients treated with conventional chemotherapy. Patients and Methods: The medical histories of all patients who developed v ery late-onset PTLD in our institution were reviewed, and diagnostic biopsy materials were retrospectively studied. Results: Very late-onset PTLDs were diagnosed in 16 (1.1%) of 1,421 patient s. Mean (+/- SD) time ta tumor onset wets 103.93 +/- 70.88 months. Most tum ors were Epstein- Barr virus-related monomorphic large-cell PTLDs of B phen otype. Ten patients received conventional chemotherapy (cyclophosphamide, d oxorubicin, vincristine, and prednisane regimen). Two of them died within 2 months, two achieved partial remission, and six achieved definitive comple te remission. Overall median survival rime was 13 months and rose to 27 mon ths in the treated group. The main cause of mortality was sepsis. None of t he treated patients experienced rejection despite withdrawal of immunosuppr essive treatment. Conclusion: Despite characteristics of aggressive lymphoma, very late-onset PTLDs after renal transplantation may respond to conventional chemotherapy . However, because a high rate of infectious complications occurred, new th erapeutic strategies, such as combinations of anti-CD20 monoclonal antibodi es and lower doses of chemotherapy, are warranted. (C) 2000 by American Soc iety of Clinical Oncology.