title: Lymphomas occurring late after solid-organ transplantation: influence of treatment on the clinical outcome.
abstract: BACKGROUND
  Posttransplant lymphoproliferative disorders (PTLDs) that occur late after solid-organ transplantation are usually a monoclonal proliferation frequently characterized by the lack of the Epstein-Barr virus genome in tumor cells. The clinical outcome and the best management for patients who present with late PTLDs still remain unclear.
  
  
  METHODS
  Thirty patients who developed PTLDs more than 12 months (range 13-156) after heart, kidney, or liver transplantation were retrospectively evaluated. Median age was 36.7 years (range 1-70). Fifty-five percent of patients presented with advanced-stage (III-IV) lymphoma, 43% of patients presented with B symptoms, and 40% of patients showed extranodal involvement. Twenty-four cases (75%) were categorized as monoclonal monomorphic PTLD.
  
  
  RESULTS
  Three patients died of progressive multiorgan failure before any treatment was initiated. Overall, 17 (63%) patients obtained a clinical response (14 patients had complete remission [CR] and 3 patients had partial remission [PR]). Eight (47%) patients are still alive and in CR, two (12%) patients died in CR, and seven (41%) patients relapsed. With a median follow-up of 6 months (range 0.5-42.8), the median overall survival was 6.2 months. Both clinical response and survival were significantly influenced by the treatment. Indeed, all patients treated for limited disease with surgery or radiotherapy in combination with modulation of immunosuppression obtained CR and are still alive and in CR. On the contrary, 33% of patients who received chemotherapy obtained a clinical response, whereas 15% of patients who received chemotherapy showed progressive disease and 50% of patients who received chemotherapy died of toxicity (infectious or multiorgan failure).
  
  
  CONCLUSIONS
  We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.
authors.affiliation: Division of Hematology, Ospedali Riuniti of Bergamo, Bergamo, Italy. gianpietrodotti@usa.net
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Dotti
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiocchi
authors.forename: Teresio
authors.initials: T
authors.lastname: Motta
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mammana
authors.forename: Eliana
authors.initials: E
authors.lastname: Gotti
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.forename: Pieremilio
authors.initials: P
authors.lastname: Cornelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.forename: Piera
authors.initials: P
authors.lastname: Viero
authors.forename: Elena
authors.initials: E
authors.lastname: Oldani
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Barbui
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008223:Lymphoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate