title: [Successful treatment with L-asparaginase-based combination chemotherapy for refractory T-cell post-transplant lymphoproliferative disorder].
abstract: A 31-year-old man underwent kidney transplantation in 1996, and had been on immunosuppressants. In 2005, he presented with discomfort on swallowing. Swelling of the left tonsil and a mediastinal mass were observed. A biopsy of the left tonsil showed a monotonous proliferation of atypical lymphocytes suggesting post-transplant lymphoproliferative disorder (PTLD). The reduction of immunosuppressants did not result in any clinical improvements, and he developed bilateral cervical lymphadenopathy. A biopsy of the cervical lymph node also showed monotonous proliferation of TdT, CD3, CD5, CD7, CD10, and CD34-positive immature cells. T-cell receptor rearrangement, but not EBER, was detected. Based on these findings, monomorphic T-cell PTLD was diagnosed. He was treated with four different chemotherapeutic regimens without any clinical improvements, and the PTLD became leukemic. Chemotherapy consisting of L-asparaginase, vincristine, and dexamethasone (LVD) was then given, which resulted in massive tumor lysis. However, after two courses of LVD, complete remission was achieved. T-cell PTLD is a rare disorder, characterized by its refractoriness to chemotherapy as opposed to B-cell PTLD. Our experience suggests that L-asparaginase-based chemotherapy may improve the prognosis of T-cell PTLD.
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine.
authors.forename: Ai
authors.initials: A
authors.lastname: Mihara
authors.forename: Chien-Kang
authors.initials: CK
authors.lastname: Chen
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ueda
authors.forename: Yuiko
authors.initials: Y
authors.lastname: Tsukada
authors.forename: Norihiro
authors.initials: N
authors.lastname: Awaya
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008297:Male; D012074:Remission Induction; D013601:T-Lymphocytes / Q000473:pathology*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D001215:Asparaginase