Lymphoma after solid organ transplantation: risk, response to therapy, and survival at a transplantation center.
OBJECTIVE
We studied the incidence, risk factors, treatment, and outcomes of post-transplantation lymphoproliferative disorder (PTLD) that occurred at the University of Michigan since 1964.


METHODS
We identified 7,040 patients who received solid organ transplantation (SOT) and post-transplantation immunosuppressive therapy. Seventy-eight patients developed PTLD.


RESULTS
Diffuse large B-cell lymphoma (n = 43), polymorphic PTLD (n = 10), Hodgkin's lymphoma (n = 7), Burkitts lymphoma (n = 6), plasmacytoma (n = 5), and mucosa-associated lymphoid tissue lymphoma (n = 3) were all over-represented in the SOT population compared with a population sample from the Surveillance, Epidemiology, and End Results (SEER) database; follicular lymphoma (n = 0) was underrepresented. Negative pretransplantation Epstein-Barr virus (EBV) serology was a risk factor for PTLD. Available histologic analysis of tumor tissue showed that 75% were CD20 positive and that 62% were EBV positive; EBV-positive tumors occurred sooner after SOT than EBV-negative tumors (mean, 29 v 66 months). Extralymphatic disease (79%), poor performance status (68%), elevated lactate dehydrogenase (LDH; 71%), and advanced stage (68%) disease were all common at the time of lymphoma diagnosis. Two thirds of patients had a complete response when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapy (either with or without rituximab). Median overall survival in all patients with PTLD was 8.23 years (95% CI, 2.28 to 30.0 years).


CONCLUSIONS
EBV-naïve patients who receive a donor organ from an EBV-infected donor are in the highest-risk situation for PTLD development. Most of these lymphomas are CD20 positive. Follicular lymphoma is unusual. With treatment, survival of patients with PTLD was indistinguishable from that of the SEER population sample.
Knight
Jason S
JS
Department of Internal Medicine, Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, USA.
Tsodikov
Alexander
A
Cibrik
Diane M
DM
Ross
Charles W
CW
Kaminski
Mark S
MS
Blayney
Douglas W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D017403:In Situ Hybridization; D053208:Kaplan-Meier Estimate; D008223:Lymphoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012367:RNA, Viral / Q000235:genetics; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014763:Viral Matrix Proteins / Q000378:metabolism
C037662:EBV-associated membrane antigen, Epstein-Barr virus; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D014763:Viral Matrix Proteins; D016559:Tacrolimus