Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome

Gianpietro Dotti, Roberto Fiocchi, Teresio Motta, Carmelo Mammana, Eliana Gotti, Silvia Riva, Pieremilio Cornelli, Bruno Gridelli, Piera Viero, Elena Oldani, Paolo Ferrazzi, Giuseppe Remuzzi, Tiziano Barbui, Alessandro Rambaldi

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102 Citations (Scopus)

Abstract

Background. Posttransplant lymphoproliferative disorders (PTLDs) that occur late after solid-organ transplantation are usually a monoclonal proliferation frequently characterized by the lack of the Epstein-Barr virus genome in tumor cells. The clinical outcome and the best management for patients who present with late PTLDs still remain unclear. Patients and Methods. Thirty patients who developed PTLDs more than 12 months (range 13-156) after heart, kidney, or liver transplantation were retrospectively evaluated. Median age was 36.7 years (range 1-70). Fifty-five percent of patients presented with advanced-stage (III-IV) lymphoma, 43% of patients presented with B symptoms, and 40% of patients showed extranodal involvement. Twenty-four cases (75%) were categorized as monoclonal monomorphic PTLD. Results. Three patients died of progressive multiorgan failure before any treatment was initiated. Overall, 17 (63%) patients obtained a clinical response (14 patients had complete remission [CR] and 3 patients had partial remission [PR]). Eight (47%) patients are still alive and in CR, two (12%) patients died in CR, and seven (41%) patients relapsed. With a median follow-up of 6 months (range 0.5-42.8), the median over-all survival was 6.2 months. Both clinical response and survival were significantly influenced by the treatment. Indeed, all patients treated for limited disease with surgery or radiotherapy in combination with modulation of immunosuppression obtained CR and are still alive and in CR. On the contrary, 33% of patients who received chemotherapy obtained a clinical response, whereas 15% of patients who received chemotherapy showed progressive disease and 50% of patients who received chemotherapy died of toxicity (infectious or multiorgan failure). Conclusions. We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.

Original languageEnglish
Pages (from-to)1095-1102
Number of pages8
JournalTransplantation
Volume74
Issue number8
Publication statusPublished - Oct 27 2002

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Organ Transplantation
Lymphoma
Lymphoproliferative Disorders
Therapeutics
Drug Therapy
Survival
Heart Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Dotti, G., Fiocchi, R., Motta, T., Mammana, C., Gotti, E., Riva, S., ... Rambaldi, A. (2002). Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome. Transplantation, 74(8), 1095-1102.

Lymphomas occurring late after solid-organ transplantation : Influence of treatment on the clinical outcome. / Dotti, Gianpietro; Fiocchi, Roberto; Motta, Teresio; Mammana, Carmelo; Gotti, Eliana; Riva, Silvia; Cornelli, Pieremilio; Gridelli, Bruno; Viero, Piera; Oldani, Elena; Ferrazzi, Paolo; Remuzzi, Giuseppe; Barbui, Tiziano; Rambaldi, Alessandro.

In: Transplantation, Vol. 74, No. 8, 27.10.2002, p. 1095-1102.

Research output: Contribution to journalArticle

Dotti, G, Fiocchi, R, Motta, T, Mammana, C, Gotti, E, Riva, S, Cornelli, P, Gridelli, B, Viero, P, Oldani, E, Ferrazzi, P, Remuzzi, G, Barbui, T & Rambaldi, A 2002, 'Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome', Transplantation, vol. 74, no. 8, pp. 1095-1102.
Dotti G, Fiocchi R, Motta T, Mammana C, Gotti E, Riva S et al. Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome. Transplantation. 2002 Oct 27;74(8):1095-1102.
Dotti, Gianpietro ; Fiocchi, Roberto ; Motta, Teresio ; Mammana, Carmelo ; Gotti, Eliana ; Riva, Silvia ; Cornelli, Pieremilio ; Gridelli, Bruno ; Viero, Piera ; Oldani, Elena ; Ferrazzi, Paolo ; Remuzzi, Giuseppe ; Barbui, Tiziano ; Rambaldi, Alessandro. / Lymphomas occurring late after solid-organ transplantation : Influence of treatment on the clinical outcome. In: Transplantation. 2002 ; Vol. 74, No. 8. pp. 1095-1102.
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title = "Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome",
abstract = "Background. Posttransplant lymphoproliferative disorders (PTLDs) that occur late after solid-organ transplantation are usually a monoclonal proliferation frequently characterized by the lack of the Epstein-Barr virus genome in tumor cells. The clinical outcome and the best management for patients who present with late PTLDs still remain unclear. Patients and Methods. Thirty patients who developed PTLDs more than 12 months (range 13-156) after heart, kidney, or liver transplantation were retrospectively evaluated. Median age was 36.7 years (range 1-70). Fifty-five percent of patients presented with advanced-stage (III-IV) lymphoma, 43{\%} of patients presented with B symptoms, and 40{\%} of patients showed extranodal involvement. Twenty-four cases (75{\%}) were categorized as monoclonal monomorphic PTLD. Results. Three patients died of progressive multiorgan failure before any treatment was initiated. Overall, 17 (63{\%}) patients obtained a clinical response (14 patients had complete remission [CR] and 3 patients had partial remission [PR]). Eight (47{\%}) patients are still alive and in CR, two (12{\%}) patients died in CR, and seven (41{\%}) patients relapsed. With a median follow-up of 6 months (range 0.5-42.8), the median over-all survival was 6.2 months. Both clinical response and survival were significantly influenced by the treatment. Indeed, all patients treated for limited disease with surgery or radiotherapy in combination with modulation of immunosuppression obtained CR and are still alive and in CR. On the contrary, 33{\%} of patients who received chemotherapy obtained a clinical response, whereas 15{\%} of patients who received chemotherapy showed progressive disease and 50{\%} of patients who received chemotherapy died of toxicity (infectious or multiorgan failure). Conclusions. We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.",
author = "Gianpietro Dotti and Roberto Fiocchi and Teresio Motta and Carmelo Mammana and Eliana Gotti and Silvia Riva and Pieremilio Cornelli and Bruno Gridelli and Piera Viero and Elena Oldani and Paolo Ferrazzi and Giuseppe Remuzzi and Tiziano Barbui and Alessandro Rambaldi",
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T1 - Lymphomas occurring late after solid-organ transplantation

T2 - Influence of treatment on the clinical outcome

AU - Dotti, Gianpietro

AU - Fiocchi, Roberto

AU - Motta, Teresio

AU - Mammana, Carmelo

AU - Gotti, Eliana

AU - Riva, Silvia

AU - Cornelli, Pieremilio

AU - Gridelli, Bruno

AU - Viero, Piera

AU - Oldani, Elena

AU - Ferrazzi, Paolo

AU - Remuzzi, Giuseppe

AU - Barbui, Tiziano

AU - Rambaldi, Alessandro

PY - 2002/10/27

Y1 - 2002/10/27

N2 - Background. Posttransplant lymphoproliferative disorders (PTLDs) that occur late after solid-organ transplantation are usually a monoclonal proliferation frequently characterized by the lack of the Epstein-Barr virus genome in tumor cells. The clinical outcome and the best management for patients who present with late PTLDs still remain unclear. Patients and Methods. Thirty patients who developed PTLDs more than 12 months (range 13-156) after heart, kidney, or liver transplantation were retrospectively evaluated. Median age was 36.7 years (range 1-70). Fifty-five percent of patients presented with advanced-stage (III-IV) lymphoma, 43% of patients presented with B symptoms, and 40% of patients showed extranodal involvement. Twenty-four cases (75%) were categorized as monoclonal monomorphic PTLD. Results. Three patients died of progressive multiorgan failure before any treatment was initiated. Overall, 17 (63%) patients obtained a clinical response (14 patients had complete remission [CR] and 3 patients had partial remission [PR]). Eight (47%) patients are still alive and in CR, two (12%) patients died in CR, and seven (41%) patients relapsed. With a median follow-up of 6 months (range 0.5-42.8), the median over-all survival was 6.2 months. Both clinical response and survival were significantly influenced by the treatment. Indeed, all patients treated for limited disease with surgery or radiotherapy in combination with modulation of immunosuppression obtained CR and are still alive and in CR. On the contrary, 33% of patients who received chemotherapy obtained a clinical response, whereas 15% of patients who received chemotherapy showed progressive disease and 50% of patients who received chemotherapy died of toxicity (infectious or multiorgan failure). Conclusions. We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.

AB - Background. Posttransplant lymphoproliferative disorders (PTLDs) that occur late after solid-organ transplantation are usually a monoclonal proliferation frequently characterized by the lack of the Epstein-Barr virus genome in tumor cells. The clinical outcome and the best management for patients who present with late PTLDs still remain unclear. Patients and Methods. Thirty patients who developed PTLDs more than 12 months (range 13-156) after heart, kidney, or liver transplantation were retrospectively evaluated. Median age was 36.7 years (range 1-70). Fifty-five percent of patients presented with advanced-stage (III-IV) lymphoma, 43% of patients presented with B symptoms, and 40% of patients showed extranodal involvement. Twenty-four cases (75%) were categorized as monoclonal monomorphic PTLD. Results. Three patients died of progressive multiorgan failure before any treatment was initiated. Overall, 17 (63%) patients obtained a clinical response (14 patients had complete remission [CR] and 3 patients had partial remission [PR]). Eight (47%) patients are still alive and in CR, two (12%) patients died in CR, and seven (41%) patients relapsed. With a median follow-up of 6 months (range 0.5-42.8), the median over-all survival was 6.2 months. Both clinical response and survival were significantly influenced by the treatment. Indeed, all patients treated for limited disease with surgery or radiotherapy in combination with modulation of immunosuppression obtained CR and are still alive and in CR. On the contrary, 33% of patients who received chemotherapy obtained a clinical response, whereas 15% of patients who received chemotherapy showed progressive disease and 50% of patients who received chemotherapy died of toxicity (infectious or multiorgan failure). Conclusions. We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.

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