title: Post-liver transplantation lymphoproliferative disorders with and without infusions of donor bone marrow cells.
abstract: Donor bone marrow cells (DBMC) infusions have been used in an attempt to decrease the untoward effects of immunosuppressive treatment and to improve immunocompetence in the post-liver transplantation (PLT) period. Between March 1987 and July 1996, 558 orthotopic liver transplantations were performed at Jackson Memorial Hospital/University of Miami. Of these, 164 patients (29%) received 10 x 10(8) DBMC/Kg using various schedules. All patients received similar immunosuppressive therapy. After a minimum follow up of 1 year, five cases of Posttransplant Lymphoproliferative Disorder (PTLD) were diagnosed in patients without DMBC (1.3%, 5/394) when compared with none (0/164) in patients who received DBMC (p = 0.15, Fisher). Four patients had malignant lymphoma and one a diffuse atypical lymphoproliferative disorder. All lymphomas were non-Hodgkin's B-cell type, three diffuse large cell lymphoma, and one mixed cell lymphoma. All PTLD tested positive for EBV by in situ hybridization. Lymphomas occurred at 2, 4, 6 months and 4 years PLT. The outcome was poor with one patient diagnosed at autopsy while two patients died a few days after diagnosis. An 8-year-old girl is the only long-term survivor (> 5 years) after a partial response to combination chemotherapy and radiation therapy. The patient with diffuse atypical lymphoproliferative disorder died 3 months later. All patients with PTLD had histologic evidence of liver rejection. Although there is no statistical significant difference between the two groups, a larger cohort of patients will determine the significance of DBMC in preventing PTLD. We believe that the infusion of cytotoxic donor T cells found in the DBMC might suppress EBV-related lymphomagenesis.
authors.affiliation: Division of Hematology/Oncology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, USA.
authors.forename: A
authors.initials: A
authors.lastname: Restrepo
authors.forename: F
authors.initials: F
authors.lastname: Albrecht
authors.forename: L E
authors.initials: LE
authors.lastname: Raez
authors.forename: H F
authors.initials: HF
authors.lastname: Fernandez
authors.forename: M
authors.initials: M
authors.lastname: Nassiri
authors.forename: G
authors.initials: G
authors.lastname: Byrne
authors.forename: P A
authors.initials: PA
authors.lastname: Cassileth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008107:Liver Diseases / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D008297:Male
chemical_list: D007166:Immunosuppressive Agents