title: Serum protein electrophoresis abnormalities in adult solid organ transplant patients with post-transplant lymphoproliferative disorder.
abstract: Post-transplant lymphoproliferative disorder (PTLD) is an Epstein-Barr virus (EBV) associated malignancy that occurs in the setting of pharmacologic immunosuppression used after organ transplantation. The presence of monoclonal gammopathy (MG) after organ transplantation is a risk factor for the development of PTLD. We retrospectively explored the characteristics of serum protein electrophoresis (SPEP) in 38 adult solid organ transplant patients with biopsy proven PTLD and SPEP. Twenty-three (61%) had MG with nine (24%) showing multiple MG. Background gammaglobulin levels were abnormal in 13 (34%) patients with five (13%) and eight (21%) having polyclonal hypergammaglobulinemia or hypogammaglobulinemia, respectively. Hypogammaglobulinemia was correlated with the presence of MG (p = 0.01) and polymorphic B-cell hyperplasia histology (p = 0.01). No correlation between SPEP findings and overall survival were noted. With median follow-up of 116 wk (range 2-261 wk), 21 (55%) patients are alive with 20 (53%) in complete remission. Response to reduction in immunosuppression was correlated with improved overall survival (262 wk vs. 68 wk, p = 0.003). Persistence of MG after complete response of the PTLD did not predict relapse. There is a high incidence of MG and gammaglobulin abnormalities in patients with PTLD.
authors.affiliation: Hematologic Malignancies Program, University of Pennsylvania Cancer Center, Philadelphia, PA 19104, USA. detsai@mail.med.upenn.edu
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Aqui
authors.forename: John E
authors.initials: JE
authors.lastname: Tomaszewski
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kotloff
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Susan C
authors.initials: SC
authors.lastname: Brozena
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hodinka
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Sunita D
authors.initials: SD
authors.lastname: Nasta
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle; D001798:Blood Proteins / Q000032:analysis*; D004586:Electrophoresis; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000097:blood* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D007166:Immunosuppressive Agents