PURPOSE: To determine whether the morphologic features of posttransplant lymphoproliferative disease (PTLD) correlated to a response to therapy. PATIENTS AND METHODS: We reviewed our experience with PTLD in the pediatric population. We identified 32 patients with a total of 36 episodes of PTLD. The diagnosis was confirmed by tissue examination and classified according to the degree of monomorphic features of the lesion. Thirty-four of 36 episodes were managed with immunosuppression reduction, and the patients were assessed for their response to this strategy. Chemotherapy was used to treat 10 of 15 patients who had progressive disease, and their subsequent course was also analyzed. RESULTS: Sixteen of 17 (94%) patients with polymorphic morphology responded to immunosuppression reduction compared with only 5 of 17 (29%) patients with monomorphic features (P < 0.001). All of the patients with progressive disease who did not receive additional therapy died. Standard chemotherapy regimens for lymphoma were administered to 10 patients with progressive disease, with a high response rate (90%), durable remissions, and acceptable toxicity. CONCLUSIONS: We conclude that the morphologic characteristics of PTLD provide information to potentially help guide treatment strategies in the management of this disease. Standard chemotherapy regimens for malignant lymphoma appear to be a viable treatment option for patients with progressive disease, although further investigation is needed.
PURPOSE: To determine whether the morphologic features of posttransplant lymphoproliferative disease (PTLD) correlated to a response to therapy. PATIENTS AND METHODS: We reviewed our experience with PTLD in the pediatric population. We identified 32 patients with a total of 36 episodes of PTLD. The diagnosis was confirmed by tissue examination and classified according to the degree of monomorphic features of the lesion. Thirty-four of 36 episodes were managed with immunosuppression reduction, and the patients were assessed for their response to this strategy. Chemotherapy was used to treat 10 of 15 patients who had progressive disease, and their subsequent course was also analyzed. RESULTS: Sixteen of 17 (94%) patients with polymorphic morphology responded to immunosuppression reduction compared with only 5 of 17 (29%) patients with monomorphic features (P < 0.001). All of the patients with progressive disease who did not receive additional therapy died. Standard chemotherapy regimens for lymphoma were administered to 10 patients with progressive disease, with a high response rate (90%), durable remissions, and acceptable toxicity. CONCLUSIONS: We conclude that the morphologic characteristics of PTLD provide information to potentially help guide treatment strategies in the management of this disease. Standard chemotherapy regimens for malignant lymphoma appear to be a viable treatment option for patients with progressive disease, although further investigation is needed.
Authors: Kavitha Ranganathan; Sarah Worley; Marian G Michaels; Susana Arrigan; Paul Aurora; Manfred Ballmann; Debra Boyer; Carol Conrad; Irmgard Eichler; Okan Elidemir; Samuel Goldfarb; George B Mallory; Peter J Mogayzel; Daiva Parakininkas; Melinda Solomon; Gary Visner; Stuart C Sweet; Albert Faro; Lara Danziger-Isakov Journal: J Heart Lung Transplant Date: 2009-10 Impact factor: 10.247
Authors: T G Gross; M A Orjuela; S L Perkins; J R Park; J C Lynch; M S Cairo; L M Smith; R J Hayashi Journal: Am J Transplant Date: 2012-08-06 Impact factor: 8.086
Authors: Alex Sandro C Machado; Alexandre Gustavo Apa; Lidia Maria Magalhães de Rezende; Nívea Dias Amoêdo; Franklin David Rumjanek; Carlos E Bacchi; Claudete Esteves Klumb Journal: Clin Exp Med Date: 2008-07-11 Impact factor: 3.984
Authors: Luis de la Cruz-Merino; Marylène Lejeune; Esteban Nogales Fernández; Fernando Henao Carrasco; Ana Grueso López; Ana Illescas Vacas; Mariano Provencio Pulla; Cristina Callau; Tomás Álvaro Journal: Clin Dev Immunol Date: 2012-08-15