Abstract
Posttransplant lymphoproliferative disorder (PTLD) represents a relatively frequent complication in solid organ or stem cell transplantation recipients. This entity encompasses a wide spectrum of lesions, those that exhibit early benign histological changes and those characterized by malignant behavior, showing diverse response to current therapeutic options. Even though these lesions can grow in multiple sites, central nervous system (CNS) localization has been described in up to 22% of cases and as primary lesions in 12%; usually PLTD in CNS is correlated with poor prognosis. Standard diagnostic and therapeutic strategies have not been clearly defined, mainly because of blood-brain barrier function. As a consequence, high dose methotrexate has been used in a similar way as in primary central nervous system lymphoma cases; additionally, new strategies such as intravenous rituximab have been reported. We describe the case of a 76 year-old liver transplant recipient who presents with gait disturbance due to a brain tumor lesion. Stereotactic biopsy was performed and CNS PTLD was diagnosed. After initial immunosuppression reduction and five cycles of high dose of rituximab plus methotrexate therapy, a very good partial response was achieved.
References
ROCKVILLE US. Department of Health and Human Services HRSA, Healthcare Systems Bureau, Division of Transplantation. Chapter 1: Trends in Organ Donation and Transplantation in the United States, 1999-2008; 2009. [acceso 08 de noviembre de 2011]. Disponible en: http://optn.transplant.hrsa.gov/ar2009/Chapter_I_AR_ CD.htm?cp=2#1.
ACTO. Cifras. Bogotá: Asociación Colombiana de Trasplantes de Organos (ACTO); 2008. [acceso 30 de enero de 2011]. Disponible en: www.actocol.org.
VEGSO G, HAJDU M, SEBESTYEN A. Lymphop-roliferative Disorders After Solid Organ Transplantation-Classification, Incidence, Risk Factors, Early Detection and Treatment Options. PatholOncolRes. 2011;17:443-454.
ABERG F, PUKKALA E, HOCKERSTEDT K, SANKILA R, ISONIEMI H. Risk of malignant neoplasms after liver transplantation: a population-based study. Liver Transpl. 2008;14:1428-1436.
TAYLOR AL, MARCUS R, BRADLEY JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56:155-167.
HARRIS N, SWERDLOW S, FRIZZERA G, KNOWLES D. Post-transplant lymphoproliferative disorders. En: Jaffe E, Harris N, Stein H, Vardiman J, eds. World Health Organization Classification of Tumours Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press; 2001:264-269.
GULLEY ML, TANG W. Using Epstein-Barr viral load assays to diagnose, monitor, and prevent posttrans-plant lymphoproliferative disorder. Clin Microbiol Rev. 2010;23:350-366.
LEBLOND V, DAVI F, CHARLOTTE F, DORENT R, BITKER MO, SUTTON L, ET AL. Posttransplant lymphoproliferative disorders not associated with Epstein-Barr virus: a distinct entity?. J Ciin Oncol. 1998;16:2052-2059.
MORTON LM, LANDGREN O, CHATTERJEE N, CASTENSON D, PARSONS R, HOOVER RN, ET AL. Hepatitis C virus infection and risk of posttransplantation lymphoproliferative disorder among solid organ transplant recipients. Blood. 2007;110:4599-4605.
AMBINDER RF, MANN RB. Detection and characterization of Epstein-Barr virus in clinical specimens. Am J Pathol 1994;145:239-252.
CHOQUET S, LEBLOND V, HERBRECHT R, SOCIE G, STOPPA AM, VANDENBERGHE P, ET AL. Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of a prospective multicenter phase 2 study. Blood. 2006;107:3053-3057.
SCHNECK SA, PENN I. Cerebral neoplasms associated with renal transplantation. Arch Neurol. 1970;22:226-233.
EICHLER AF, BATCHELOR TT. Primary central nervous system lymphoma: presentation, diagnosis and staging. NeurosurgFocus. 2006;21:e15.
BATCHELOR T, LOEFFLER JS. Primary CNS lymphoma. J Clin Oncol 2006;24:1281-1288.
BATCHELOR T, CARSON K, O'NEILL A, GROSSMAN SA, ALAVI J, NEW P, ET AL. Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol. 2003;21:1044-1049.
SCHNECK S, PENN I. De-Novo brain tumours in renal-transplant recipients. The Lancet. 1971;297:983-986.
PARKER A, BOWLES K, BRADLEY JA, EMERY V, FEATHERSTONE C, GUPTE G, ET AL. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol. 2010;149:675-692.
PENN I, PORAT G. Central nervous system lymphomas in organ allograft recipients. Transplantation. 1995;59:240-244.
EVENS AM, DAVID KA, HELENOWSKI I, NELSON B, KAUFMAN D, KIRCHER SM, ET AL. Multicenter analysis of 80 solid organ transplantation recipients with post-transplantation lymphoproliferative disease: outcomes and prognostic factors in the modern era. J Clin Oncol. 2010;28:1038-1046.
CAVALIERE R, PETRONI G, LOPES MB, SCHIFF D. Primary central nervous system post-transplantation lymphoproliferative disorder: an International Primary Central Nervous System Lymphoma Collaborative Group Report. Cancer. 2010;116:863-870.
TANG YZ, BOOTH TC, BHOGAL P, MALHOTRA A, WILHELM T. Imaging of primary central nervous system lymphoma. Clin Radiol. 2011;66:768-777.
ABREY LE, BATCHELOR TT, FERRERI AJ, GOSPODAROWICZ M, PULCZYNSKI EJ, ZUCCA E, ET AL. Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Cin Oncol. 2005;23:5034-5043.
CASTELLANO-SANCHEZ AA, LI S, QIAN J, LAGOO A, WEIR E, BRAT DJ. Primary central nervous system posttransplant lymphoproliferative disorders. Am J Cin Pathol 2004;121:246-253.
NABORS LB, PALMER CA, JULIAN BA, PRZE-KWAS AM, KEW CE. Isolated central nervous system posttransplant lymphoproliferative disorder treated with high-dose intravenous methotrexate. Am J Transplant. 2009;9:1243-1248.
TSAI DE, HARDY CL, TOMASZEWSKI JE, KOT-LOFF RM, OLTOFF KM, SOMER BG, ET AL. Reduction in immunosuppression as initial therapy for posttransplant lymphoproliferative disorder: analysis of prognostic variables and long-term follow-up of 42 adult patients. Transplantation. 2001;71:1076-1088.
CHOQUET S, LEBLOND V, HERBRECHT R, SOCIE G, STOPPA A-M, VANDENBERGHE P, ET AL. Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of a prospective multicenter phase 2 study. Blood 2006;107:3053-3057.
ELDER JB, CHEN TC. Surgical interventions for primary central nervous system lymphoma. Neurosurg Focus 2006;21:e13.
STEPHAN JL, LE DEIST F, BLANCHE S, LE BIDOIS J, PEUCHMAUR M, LELLOUCH-TUBIANA A, ET AL. Treatment of central nervous system B lymphoproliferative syndrome by local infusion of a B cell-specific monoclonal antibody. Transplantation. 1992;54:246-249.
RUBENSTEIN JL, COMBS D, ROSENBERG J, LEVY A, MCDERMOTT M, DAMON L, ET AL. Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood. 2003;101:466-468.
WONG ET, TISHLER R, BARRON L, WU JK. Immunochemotherapy with rituximab and temozolo-mide for central nervous system lymphomas. Cancer. 2004;101:139-145.
TRAUM AZ, RODIG NM, PILICHOWSKA ME, SOMERS MJ. Central nervous system lymphoproliferative disorder in pediatric kidney transplant recipients. Pediatr Transplant. 2006;10:505-512.
KORDELAS L, TRENSCHEL R, KOLDEHOFF M, ELMAAGACLI A, BEELEN DW. Successful treatment of EBV PTLD with CNS lymphomas with the monoclonal anti-CD20 antibody rituximab. Onkologie. 2008;31:691-693.
PATRICK A, WEE A, HEDDERMAN A, WILSON D, WEISS J, GOVANI M. High-dose intravenous rituximab for multifocal, monomorphic primary central nervous system posttransplant lymphoproliferative disorder. J Neurooncol. 2011;103:739-743.
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