title: Bone marrow involvement by lymphoproliferative disorders after solid-organ transplant.
abstract: OBJECTIVE
  Posttransplant lymphoproliferative disorders are classified as monomorphic, polymorphic, early lesions, or Hodgkin lymphoma. Bone marrow staging examination is recommended in posttransplant lymphoproliferative disorder patients. However, information about bone marrow involvement in these disorders is scarce. We evaluated 19 transplant patients with posttransplant lymphoproliferative disorder to investigate incidence of bone marrow involvement, associated morphologic changes, and prognosis.
  
  
  METHODS
  We retrospectively assessed bone marrow findings of 19 transplant patients with posttransplant lymphoproliferative disorder who underwent bone marrow staging at Baskent University from 1985 to 2013. Clinical and pathologic data were reviewed from the medical records. Follow-up information was obtained from medical records or communication with patients or families. Data collected including age, sex, Epstein-Barr virus status, immunosuppressive therapy, elapsed time from transplant to diagnosis of posttransplant lymphoproliferative disorder, B symptoms, number of extranodal sites, involvement of different organs, Ann Arbor clinical staging, hematologic parameters, and serum lactate dehydrogenase levels.
  
  
  RESULTS
  There were 5 of 19 patients (26.3%) who had bone marrow involvement with posttransplant lymphoproliferative disorder, including 2 patients diagnosed with posttransplant lymphoproliferative disorder by lymph node biopsy and 1 patient each diagnosed by native liver biopsy, nasopharyngeal biopsy, or allograft liver biopsy. In 4 patients, there was monomorphic posttransplant lymphoproliferative disorder subtype and 1 patient had early lesion posttransplant lymphoproliferative disorder subtype. In 10 of 19 patients (52.6%), Epstein-Barr virus was detected with in situ hybridization, including 3 patients with bone marrow involvement who were diagnosed with Burkitt lymphoma (n = 1), diffuse large B-cell lymphoma (n = 1), or early lesion (n = 1).
  
  
  CONCLUSIONS
  Patients with posttransplant lymphoproliferative disorder have high incidence of bone marrow involvement and high mortality rates. Therefore, bone marrow examination may be important in the diagnosis and staging evaluation of posttransplant lymphoproliferative disorder.
authors.affiliation: From the Department of Pathology, Baskent University, Faculty of Medicine, Ankara, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Akar Özkan
authors.forename: B Handan
authors.initials: BH
authors.lastname: Özdemir
authors.forename: Eda
authors.initials: E
authors.lastname: Yılmaz Akçay
authors.forename: Ayşen
authors.initials: A
authors.lastname: Terzi
authors.forename: Sema
authors.initials: S
authors.lastname: Karakuş
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology* / Q000821:virology; D001856:Bone Marrow Examination; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics; D020031:Epstein-Barr Virus Infections / Q000276:immunology / Q000473:pathology / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D015994:Incidence; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004279:DNA, Viral