Serum protein electrophoresis abnormalities in adult solid organ transplant patients with post-transplant lymphoproliferative disorder.
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.
Tsai
Donald E
DE
Hematologic Malignancies Program, University of Pennsylvania Cancer Center, Philadelphia, PA 19104, USA. detsai@mail.med.upenn.edu
Aqui
Nicole A
NA
Tomaszewski
John E
JE
Olthoff
Kim M
KM
Ahya
Vivek N
VN
Kotloff
Robert M
RM
Bloom
Roy D
RD
Brozena
Susan C
SC
Hodinka
Richard L
RL
Stadtmauer
Edward A
EA
Schuster
Stephen J
SJ
Nasta
Sunita D
SD
Porter
David L
DL
Luger
Selina M
SM
Klumpp
Thomas R
TR
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
D015415:Biomarkers; D001798:Blood Proteins; D007166:Immunosuppressive Agents