title: Pediatric post-transplant diffuse large B cell lymphoma after cardiac transplantation.
abstract: Post-transplant lymphoproliferative disorders (PTLDs) occur in 3.5-9% of patients after pediatric cardiac transplantation. Caution is needed when treating patients with PTLD because of the risk of allograft rejection frequently caused by withdrawal of immunosuppression. In this report, we describe a 47-month-old boy who developed PTLD as an ileocecal mass 29 months after cardiac transplantation. Immunosuppressive therapy with cyclosporine A (CyA) had been reduced due to an elevation of Epstein-Barr virus (EBV) titer for 8 months before development of PTLD. Histology of the tumor was diffuse large B cell lymphoma. EBV was detected by in situ hybridization assay. Cytogenetic analysis revealed t(8;14)(q24;q32) and Southern blot analysis detected a c-Myc rearrangement. He was treated with rituximab and combination chemotherapy with excellent response. CyA dose was maintained at reduced levels during chemotherapy and later minimized with introduction of everolimus. The child is free of both PTLD and allograft rejection 41 months after the diagnosis of PTLD.
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Kusuki
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Hashii
authors.affiliation: Department of Transplantation Medicine, Osaka University Hospital, Osaka, Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Fukushima
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Takizawa
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Sadao
authors.initials: S
authors.lastname: Tokimasa
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Shigetoyo
authors.initials: S
authors.lastname: Kogaki
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan. ohta@ped.med.osaka-u.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ohta
authors.affiliation: Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Tsuda
authors.affiliation: Division of Pathology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ozono
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects*; D020732:Cytogenetic Analysis; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D016572:Cyclosporine