Treatment of postrenal transplantation lymphoproliferative disease manifesting as plasmacytoma with nonmyeloablative hematopoietic stem cell transplantation from the same kidney donor.
Posttransplantation lymphoproliferative disease (PTLD) presenting as an Epstein-Barr-virus (EBV)-related nasal plasmacytoma developed in a renal-allograft recipient 13 years after transplantation. Systemic dissemination occurred despite immunosuppression withdrawal, surgery, irradiation, and chemotherapy. A nonmyeloablative hematopoietic-stem-cell-transplantation (HSCT) with peripheral blood HSC from the kidney donor was performed. With the onset of graft-versus-host disease, resolution of the systemic disease was demonstrated clinically and molecularly by serial quantification of plasma EBV-DNA. Isolated relapse occurred in the central nervous system (CNS), a known tumour sanctuary site, ultimately leading to death. Nonmyeloablative HSCT might be considered a cellular therapy for PTLD, but possible CNS relapse must be effectively tackled.
Au
W Y
WY
University Department of Medicine, Queen Mary Hospital, Hong Kong.
Lie
A K W
AK
Chan
E C
EC
Pang
A
A
Ma
S K
SK
Choy
C
C
Kwong
Y L
YL
D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D004854:Herpesvirus 4, Human; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy / Q000821:virology; D008297:Male; D009669:Nose Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy / Q000821:virology; D010954:Plasmacytoma / Q000175:diagnosis*; D014019:Tissue Donors