Open AccessPlasmacytic post‐transplant lymphoproliferative disorder: a case series of nine patients
Author(s) -
Karuturi Meghan,
Shah Nirav,
Frank Dale,
Fasan Omotayo,
Reshef Ran,
Ahya Vivek N.,
Bromberg Michael,
Faust Thomas,
Goral Simin,
Schuster Stephen J.,
Stadtmauer Edward A.,
Tsai Donald E.
Publication year - 2013
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12091
Subject(s) - medicine , immunosuppression , post transplant lymphoproliferative disorder , lymphoproliferative disorders , pathology , histology , monoclonal , multiple myeloma , gastroenterology , transplantation , rituximab , immunology , lymphoma , monoclonal antibody , antibody
Summary Post‐transplant lymphoproliferative disorder ( PTLD ) is a serious complication of organ transplantation. Although PTLD typically has a B‐cell histology, an uncommon variant, plasmacytic PTLD can present as a monoclonal plasma cell proliferation similar to plasmacytomas seen in multiple myeloma. A retrospective analysis was performed on nine patients at our center with plasmacytic PTLD as characterized by plasmacytic histology with the presence of CD 138 and lack of CD 20. Of the 210 adult solid organ transplant PTLD patients diagnosed between 1988 and 2012, 9 (4%) had a histological appearance consistent with plasmacytic PTLD . The median time from transplant to diagnosis was 3.7 years (range 8 months–24 years). All patients presented with extranodal and often subcutaneous solid tumors. Laboratory features included elevated LDH and beta‐2 microglobulin levels, monoclonal gammopathy, and EBV positivity of the tumor. Unlike conventional multiple myeloma, patients had normal calcium levels and only mild anemia. Six patients who have completed treatment achieved complete responses with radiation therapy and/or reduction in immunosuppression with two patients now greater than 5 years in continuous complete response. Plasmacytic PTLD , despite its plasmacytic histology, is responsive to conventional therapies used for B‐cell PTLD including reduction in immunosuppression and radiation therapy.