Post-transplant hepatosplenic T-cell lymphoma successfully treated with HyperCVAD regimen.
Hepatosplenic T-cell lymphoma (HSTL) is an aggressive lymphoma. In post-transplant immunosuppressed patients, HSTL is usually rapidly fatal. We report successful treatment of post-transplant HSTL in a 50-year-old renal allograft recipient by reducing immunosuppression and using intensive chemotherapy consisting of alternating cycles of HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and MTX/HiDAC (methotrexate, Ara-C). Remission is ongoing at 8+ years. Literature review identified another 20 cases of HSTL in solid organ transplant recipients: median survival was 4 months; no other patients survived beyond 12 months. Bone marrow involvement was universal, but changes were often subtle: 6 of 12 cases had nondiagnostic examinations earlier on. High index of suspicion may lead to more timely diagnosis of this uncommon form of post-transplant lymphoproliferative disorder, and treatment with intensive chemotherapy such as HyperCVAD may be curative.
Tey
Siok-Keen
SK
Department of Clinical Hematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. siok_tey@health.qld.gov.au
Marlton
Paula V
PV
Hawley
Carmel M
CM
Norris
Debra
D
Gill
Devinder S
DS
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis; D012074:Remission Induction; D013160:Splenic Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
D016692:Receptors, Antigen, T-Cell, gamma-delta; D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate