title: Plasmacytic post-transplant lymphoproliferative disorder: a case series of nine patients.
abstract: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. Although PTLD typically has a B-cell histology, an uncommon variant, plasmacytic PTLD can present as a monoclonal plasma cell proliferation similar to plasmacytomas seen in multiple myeloma. A retrospective analysis was performed on nine patients at our center with plasmacytic PTLD as characterized by plasmacytic histology with the presence of CD138 and lack of CD20. Of the 210 adult solid organ transplant PTLD patients diagnosed between 1988 and 2012, 9 (4%) had a histological appearance consistent with plasmacytic PTLD. The median time from transplant to diagnosis was 3.7 years (range 8 months-24 years). All patients presented with extranodal and often subcutaneous solid tumors. Laboratory features included elevated LDH and beta-2 microglobulin levels, monoclonal gammopathy, and EBV positivity of the tumor. Unlike conventional multiple myeloma, patients had normal calcium levels and only mild anemia. Six patients who have completed treatment achieved complete responses with radiation therapy and/or reduction in immunosuppression with two patients now greater than 5 years in continuous complete response. Plasmacytic PTLD, despite its plasmacytic histology, is responsive to conventional therapies used for B-cell PTLD including reduction in immunosuppression and radiation therapy.
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Karuturi
authors.forename: Nirav
authors.initials: N
authors.lastname: Shah
authors.forename: Dale
authors.initials: D
authors.lastname: Frank
authors.forename: Omotayo
authors.initials: O
authors.lastname: Fasan
authors.forename: Ran
authors.initials: R
authors.lastname: Reshef
authors.forename: Vivek N
authors.initials: VN
authors.lastname: Ahya
authors.forename: Michael
authors.initials: M
authors.lastname: Bromberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Faust
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
mesh_terms: D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008223:Lymphoma / Q000150:complications*; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D010950:Plasma Cells / Q000473:pathology; D010954:Plasmacytoma / Q000209:etiology*; D012189:Retrospective Studies