Post-transplant lymphoproliferative diseases in Asian solid organ transplant recipients: late onset and favorable response to treatment.

Nineteen consecutive patients with post-transplant lymphoproliferative disorders (PTLD) in an Asian population were reviewed. The histopathologic diagnoses were monomorphic (CD20-positive diffuse large B-cell lymphoma, n = 14); plasmacytic (n = 1); Burkitt-like (n = 1); natural killer cell lymphoma (n = 1); lymphomatoid papulosis (n = 1); and classical Hodgkin lymphoma (n = 1). Early-onset (<one yr post-transplantation) PTLD constituted only 10% of cases, and all were Epstein-Barr virus (EBV) positive. EBV-negative cases (n = 6) developed at a median of 92 (19-170) months, whereas EBV-positive cases occurred later at 128 (7-230) months. With reduction of immunosuppression followed by local therapy, treatment with the anti-CD20 antibody rituximab with or without combination chemotherapy, complete remission was achieved in 17/19 (90%) of cases. Lactate dehydrogenase level, stage, extranodal involvement, EBV status, and International Prognostic Index had no impact on treatment outcome. EBV-positive PTLD occurred much later in Asian patients. Treatment results of PTLD were favorable.