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Post transplant lymphoproliferative disease

Masatoshi Matsunami, Yoshifumi Ubara, Keiichi Sumida, Yoichi Oshima, Masahiko Oguro, Kazuya Kinoshita, Kiho Tanaka, Yuki Nakamura, Keiichi Kinowaki, Kenichi Ohashi, Takeshi Fujii, Takuro Igawa, Yasuharu Sato, Yasuo Ishii
BACKGROUND: Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disease characterized by systemic inflammatory reactions associated with the dysregulated production of interleukin-6 (IL-6). In patients with MCD, renal involvement is uncommon, with only one report published regarding kidney transplantation (KTx) to treat end-stage renal disease (ESRD) secondary to MCD. Recent clinical observations have shown that IL-6 production is implicated in allograft rejection, while IL-6 receptor blockade (with tocilizumab [TCZ]) reduces alloantibody generation and thereby improves graft survival; however, the efficacy and safety of TCZ in MCD patients undergoing KTx is still unknown...
October 11, 2018: BMC Nephrology
Bojana Misheva, Roy Hajjar, Hugo Chapdelaine, Herawaty Sebajang, Frank Schwenter
An ectopic pancreas, also known as pancreatic rest or heterotopic pancreas, consists of pancreatic tissue found in a location with no continuity with the anatomic pancreas. This lesion can occasionally cause gastrointestinal obstruction, ulceration or become inflamed and cause ectopic pancreatitis. We present the case of a 29-year-old immunocompromised female patient due to a previous kidney transplant. She presented with nausea and vague abdominal discomfort and was admitted for investigation and treatment of an acute kidney injury...
October 2018: Journal of Surgical Case Reports
Vincent Thibaud, Joseph Rivalan, Francisco Llamas, Mathilde Cherel, Olivier Decaux, Cécile Vigneau
Post-transplantation lymphoproliferative disorder (PTLD) is a well-know complication after organ transplantation. We report a case of a patient who developed an extramedullary plasmacytoma-like PTLD around his transplanted kidney treated with standard multiple myeloma chemotherapy. Three years after benefiting of a deceased donor kidney transplant for an end stage kidney disease secondary to nephroangiosclerosis, our patient developed an extra-medullary plasmacytoma confined to the transplant compartment. The transplant function was unaltered, and due to the absence of reduction of the lesion after immunosuppression reduction, a chemotherapy by bortezomib-cyclophosphamide-dexamethasone (VCD) known to be efficient in multiple myeloma was initiated...
October 6, 2018: Néphrologie & Thérapeutique
Wang Kedi, Xu Dongjiang, Lv Zhi, Gao Yan, Jia Kun, Su Jianrong
Background Epstein-Barr virus (EBV) DNA load monitoring in blood is essential for the diagnosis of EBV-associated diseases. However, the best-suited blood compartment for detection is still under discussion. The aim of this study was to evaluate the diagnostic value of EBV-DNA load in peripheral blood mononuclear cells (PBMC), plasma and whole blood (WB) samples. Methods A total of 156 patients, including 45 patients with infectious mononucleosis (IM), 57 patients with EBV-associated hemophagocytic lymphohistiocytosis (HLH) and 54 patients with post-transplant lymphoproliferative disorders (PTLD), were enrolled in this study...
September 29, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Lauren P McLaughlin, Rayne Rouce, Stephen Gottschalk, Vicky Torrano, George Carrum, Meng-Fen Wu, Fahmida Hoq, Bambi Grilley, Andrea M Marcogliese, Patrick J Hanley, Adrian P Gee, Malcolm K Brenner, Cliona M Rooney, Helen E Heslop, Catherine M Bollard
Autologous T cells targeting Epstein Barr virus (EBV) latent membrane proteins (LMPs) have shown safety and efficacy for the treatment of patients with type II latency EBV-associated lymphomas who have failed standard therapies, including high dose chemotherapy followed by autologous stem cell rescue. However, the safety and efficacy of allogeneic donor-derived LMP-specific T cells (LMP-Ts) have not been established for patients who have received allogeneic HSCT. Thus, we evaluated the safety and efficacy of donor-derived LMP-Ts in 26 patients who had received an allogeneic hematopoietic stem cell transplant (HSCT) for EBV-associated T/NK or B cell lymphomas (NCT00062868, NCT01956084; ClinicalTrials...
September 27, 2018: Blood
Jessica Roberts, Jason Powell, Michael W Mather, Steven Powell, Malcolm Brodlie
OBJECTIVE: Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation...
November 2018: International Journal of Pediatric Otorhinolaryngology
Kieran Sahasrabudhe, Mario Otto, Peiman Hematti, Vaishalee Kenkre
Allogeneic hematopoietic stem cell transplantation is a curative option for patients with a variety of diseases. Transplantation from a related haploidentical donor is being increasingly utilized for patients who lack an available human leukocyte antigen matched related or unrelated donor. One of the strategies used for haploidentical transplants involves selective depletion of T cells expressing the αβ T cell receptor and CD19+ B cells prior to transplant. This allows for the removal of cells responsible for graft-versus-host disease and post-transplant lymphoproliferative disorder but maintains hematopoietic progenitor and stem cells for engraftment (CD34+ cells), as well as cells to elicit graft-versus-tumor effect and provide anti-infective activity (such as gamma-delta T cells and natural killer cells)...
September 6, 2018: Leukemia & Lymphoma
Anna Francis, David W Johnson, Jonathan Craig, Armando Teixeira-Pinto, Germaine Wong
Better prognostication of graft and patient outcomes among kidney transplant recipients with post-transplant lymphoproliferative disease (PTLD) in the rituximab era is needed to inform treatment decisions. Therefore, we sought to estimate the excess risks of death and graft loss in kidney transplant recipients with PTLD, and to determine risk factors for death. Using the ANZDATA registry, the risks of mortality and graft loss among recipients with and without PTLD were estimated using survival analysis. A group of 367 patients with PTLD (69% male, 85% white, mean age 43 years) were matched 1 to 4 to 1468 controls (69% male, 88% white, mean age 43 years), and followed for a mean of 16 years...
October 2018: Kidney International
Maurizio Salvadori, Aris Tsalouchos
Data from World Health Organization estimates that the hepatitis C virus (HCV) prevalence is 3% and approximately 71 million persons are infected worldwide. HCV infection is particularly frequent among patients affected by renal diseases and among those in dialysis treatment. In addition to produce a higher rate of any cause of death, HCV in renal patients and in renal transplanted patients produce a deterioration of liver disease and is a recognized cause of transplant glomerulopathy, new onset diabetes mellitus and lymphoproliferative disorders...
August 9, 2018: World Journal of Transplantation
Burkhard Tönshoff, Robert Ettenger, Luca Dello Strologo, Stephen D Marks, Lars Pape, Helio Tedesco-Silva Junior, Anna Bjerre, Martin Christian, Matthias Meier, El-Djouher Martzloff, Barbara Rauer, Jennifer Ng, Patricia Lopez
In a 12-month, multicenter, open-label study, 106 children were randomized at 4-6 weeks after kidney transplantation to switch to everolimus with reduced TAC (EVR/rTAC) and steroid elimination from month 5 post-transplant or to continue standard tacrolimus with mycophenolate mofetil (sTAC/MMF) and steroids. The cumulative incidence of a co-primary efficacy endpoint (biopsy-proven acute rejection [BPAR], graft loss or death from randomization to month 12) was 10.3% with EVR/rTAC and 5.8% with sTAC/MMF (difference 4...
August 20, 2018: American Journal of Transplantation
Céline Habre, Paola M Soccal, Frédéric Triponez, John-David Aubert, Thorsten Krueger, Steve P Martin, Joanna Gariani, Jean-Claude Pache, Frédéric Lador, Xavier Montet, Anne-Lise Hachulla
Complications following lung transplantation may impede allograft function and threaten patient survival. The five main complications after lung transplantation are primary graft dysfunction, post-surgical complications, alloimmune responses, infections, and malignancy. Primary graft dysfunction, a transient ischemic/reperfusion injury, appears as a pulmonary edema in almost every patient during the first three days post-surgery. Post-surgical dysfunction could be depicted on computed tomography (CT), such as bronchial anastomosis dehiscence, bronchial stenosis and bronchomalacia, pulmonary artery stenosis, and size mismatch...
August 15, 2018: Insights Into Imaging
Samantha Correia, Ray Bridges, Fanny Wegner, Cristina Venturini, Anne Palser, Jaap M Middeldorp, Jeffrey I Cohen, Mario A Lorenzetti, Irene Bassano, Robert E White, Paul Kellam, Judith Breuer, Paul J Farrell
138 new Epstein-Barr virus (EBV) genome sequences have been determined. 125 of these and 116 from previous reports were combined to produce a multiple sequence alignment of 241 EBV genomes, which we have used to analyze variation within the viral genome. The type 1/type2 classification of EBV remains the major form of variation and is defined mostly by EBNA2 and EBNA3, but the type 2 SNPs at the EBNA3 locus extend into the adjacent gp350 and gp42 genes, whose products mediate infection of B cells by EBV. A small insertion within the BART miRNA region of the genome was present in 21 EBV strains...
August 15, 2018: Journal of Virology
Bruno Roque-Lima, Caroline Correa de Tulio Augusto Roque, Maria Dirlei Begnami, Patricia Peresi, Eduardo Nobrega Pereira Lima, Celso Abdon Lopes de Mello, Felipe JoséFernandez Coimbra, Rubens Chojniak, Tiago Goss Santos
Liver metastasis is the major cause of death for patients with colorectal cancer. Despite treatment with surgery and chemotherapy, patient outcomes are quite unfavourable. Thus, there is an urgent need to develop new treatment strategies with the associated establishment of good animal models. Metastatic disease can be modelled using patient-derived orthotopic xenografts, which accurately replicate intra-tumoral heterogeneity so that various chemotherapeutic agents can be tested on individual tumours to aid in clinical decision-making...
September 5, 2018: Journal of Drug Targeting
Yasodha Natkunam, Dita Gratzinger, Amy Chadburn, John R Goodlad, John K C Chan, Jonathan Said, Elaine S Jaffe, Daphne de Jong
Immunodeficiency-associated lymphoproliferative disorders (IA-LPDs) are pathologically and clinically heterogeneous. In many instances, similar features are shared by a spectrum of IA-LPDs in clinically diverse settings. The World Health Organization (WHO), however, classifies IA-LPDs by their immunodeficiency setting largely according to the paradigm of post-transplant lymphoproliferative disorders (PTLD), but with inconsistent terminology and disease definitions. The field currently lacks standardization and would greatly benefit from thinking across immunodeficiency categories by adopting a common working vocabulary to better understand these disorders and guide clinical management...
August 6, 2018: Blood
O Mazanowska, P Donizy, J Kuźmińska, K Roczek, A Zimny, M Banasik, D Kaminska, K Hap, M Klinger, A Halon
INTRODUCTION: Acute central nervous system (CNS) damage in a patient who has received organ transplant is an extremely difficult and complex clinical issue that spans a wide spectrum of differential diagnoses with ischemia, post-transplant lymphoproliferative disorders (PTLDs), infections, lymphomas, and progressive multifocal leukoencephalopathy (PML). PTLDs are a clinically and histopathologically heterogeneous group of diseases that most often occur in heavily immunocompromised populations after solid organ transplantation (SOT), probably related to the infection or reactivation of Epstein-Barr virus (EBV) infection, whereas PML is an infectious disease caused by the John Cunningham virus (JCV)...
July 2018: Transplantation Proceedings
Thomas S Rogers, Laura McGevna, Deborah L Cook
Post-transplant lymphoproliferative disease (PTLD) is a rare lymphoid and/or plasmacytic proliferation that occurs in the context of immunosuppression because of solid organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT). PTLD is the most common cancer in children who receive a SOT or HSCT, occurring in up to 13% of these patients. The majority of PTLDs are extracutaneous B-cell lymphomas, with only 12% to 14%, representing the T-cell phenotype. PTLDs can involve the skin and behave like an aggressive lymphoma, and are among the most serious and potentially fatal complications of transplantation...
July 27, 2018: Journal of Cutaneous Pathology
Masaaki Hotta, Aya Nakaya, Shinya Fujita, Atsushi Satake, Takahisa Nakanishi, Yoshiko Azuma, Yukie Tsubokura, Akiko Konishi, Hideaki Yoshimura, Tomoki Ito, Kazuyoshi Ishii, Shosaku Nomura
Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication of organ transplantation. Progress has recently been made in the pathological classification of PTLD. However, the clinical course has not been clarified because of the rarity of this disease. We experienced a case of PTLD with a fulminant clinical course. The patient had been under longterm immunosuppressive treatment for aplastic anemia. He received related allogeneic hematopoietic stem cell transplantation. Soon after transplantation, he developed PTLD...
May 14, 2018: Hematology Reports
Arjun Datt Law, Maria Queralt Salas, Wilson Lam, Fotios V Michelis, Santhosh Thyagu, Dennis Dong Hwan Kim, Jeffrey Howard Lipton, Rajat Kumar, Hans Messner, Auro Viswabandya
Haploidentical hematopoietic stem cell transplantation (haploHSCT) with conditioning regimens using post-transplant cyclophosphamide (PTCy) for peripheral blood stem cell (PBSC) grafts is limited by comparably higher rates of acute and chronic graft-versus-host disease (GVHD). Antithymocyte globulin (ATG) may mitigate this risk. We evaluated haploHSCT after reduced-intensity conditioning (RIC) with ATG, PTCy, and cyclosporine to prevent rejection and GVHD. Fifty adults underwent haploHSCT from August 2016 to February 2018...
August 7, 2018: Biology of Blood and Marrow Transplantation
Bo-Kyoung Park, Hyo-Sup Kim, Seongkoo Kim, Jae-Wook Lee, Young Shil Park, Pil-Sang Jang, Nack-Gyun Chung, Dae-Chul Jeong, Bin Cho
Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy for β-thalassemia major (TM) and sickle cell disease (SCD) in children. Graft-versus-host disease (GVHD) and treatment-related mortality (TRM) remain significant challenges to improving survival after HSCT. Here, we analyzed the outcome of TM and SCD patients, who received allogeneic HSCT with myeloablative conditioning at our institution. Methods: Twenty-two patients (15 TM, 7 SCD), with a median age of 9 years (range, 1...
June 2018: Blood Research
Yuhua Ru, Jia Chen, Depei Wu
Epstein-Barr virus (EBV) viremia and post-transplant lymphoproliferative disease (PTLD) are severe complications after hematopoietic stem cell transplantation (HSCT). A series of risk factors have been found to predict EBV viremia and PTLD, including the T-cell depletion, reduced intensity conditioning, and alternative donor. The rituximab pre-emptive therapy could improve PTLD prognosis significantly, but the trigger of initiating rituximab pre-emptive therapy has not been well established. Additionally, EBV-specific cytotoxic T cell (CTL) is a promising approach to treat EBV-PTLD...
September 2018: European Journal of Haematology
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