title: Post-transplant lymphoproliferative disorders (PTLD) after renal transplantation: management and evolution of seven cases among 1002 renal transplants in São Paulo, Brazil.
abstract: We reported seven cases (0.7%) of PTLD among 1002 renal transplants performed at Renal Transplant Service from Hospital São Paulo-Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil, between 1976 and 1997. There were three male and four female patients with median age of 37 year-old. According to Ann Arbor staging system there were four localized extra-nodal intermediate-grade NHL, one disseminated low-grade NHL and two polyclonal lymphoid hyperplasia. Four patients received cadaveric, two received related and one received unrelated renal transplant. PTLD occurred after a median latency period of 36 months (ranging from 5 to 84 months). In situ hybridization for EBER1 was performed in five patients and molecular evidence of EBV was found in 3 cases (two DLCL and one lymphoplasmocytoid lymphoma). All patients were treated with immunosuppression withdrawal, four patients received anthracyclin-based chemotherapy for control of localized or systemic clonal disease and three were treated with resection of primary PTLD. Four of seven patients (57%) are in complete remission 11, 20, 25 and 79 months after PTLD onset. One patient lost follow-up and two patients died due to lymphoma relapse, respectively 4 and 10 months after completion of treatment. In conclusion, our experience with this small group of patients showed that: 1) immunosuppression withdrawal is not necessarily associated with loss of renal transplant and can be used as the only treatment for polyclonal PTLD; 2) chemotherapy can simultaneously lead to clonal PTLD remission and periodic immunosuppression, avoiding graft rejection after immunosuppression withdrawal.
authors.affiliation: Hematology and Transfusion Service, Escola Paulista de Medicina-Universidade Federal de São Paulo, Brazil.
authors.forename: G W
authors.initials: GW
authors.lastname: Colleoni
authors.forename: J S
authors.initials: JS
authors.lastname: Oliveira
authors.forename: D M
authors.initials: DM
authors.lastname: Borducchi
authors.forename: M A
authors.initials: MA
authors.lastname: Fernandes
authors.forename: H T
authors.initials: HT
authors.lastname: Da Silva
authors.forename: A C
authors.initials: AC
authors.lastname: Alves
authors.forename: M F
authors.initials: MF
authors.lastname: De Franco
authors.forename: J
authors.initials: J
authors.lastname: Kerbauy
authors.forename: J O
authors.initials: JO
authors.lastname: Pestana
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity; D001938:Brazil; D003131:Combined Modality Therapy; D019468:Disease Management; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000633:toxicity; D016030:Kidney Transplantation / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000139:chemically induced / Q000209:etiology / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000139:chemically induced / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome
chemical_list: C099537:Epstein-Barr virus encoded RNA 1; D007166:Immunosuppressive Agents; D012367:RNA, Viral