Open AccessDouble-hit monomorphic B-cell lymphoma after liver transplantation
Author(s) -
Zabreen Tahir,
J. H. Peters,
K. Leahy,
Felipe Batalini
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-231831
Subject(s) - medicine , rituximab , immunosuppression , transplantation , prednisone , vincristine , liver transplantation , gastroenterology , lymphoplasmacytic lymphoma , post transplant lymphoproliferative disorder , lymphoma , pathology , cyclophosphamide , chemotherapy , waldenstrom macroglobulinemia
We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd-Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen.