Abstract: TH-PO574
Breaking the Rules on PTLD
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Bunce, Brittaini D., University of Texas Health Science Center, San Antonio, Texas, United States
- Gandhi, Jeet, University of Texas Health Science Center, San Antonio, Texas, United States
- Dado, David N., University of Texas Health Science Center, San Antonio, Texas, United States
- Ding, Yanli, University of Texas Health Science Center, San Antonio, Texas, United States
- Bhayana, Suverta, University of Texas Health Science Center, San Antonio, Texas, United States
Introduction
Early post-transplant lymphoproliferative disorder (PTLD) is mostly, but not invariably, associated with Epstein-Barr virus (EBV) infection. Most EBV-negative PTLDs occur more than a year post-transplant (median 50 months versus 10 for EBV-positive) with the majority being monomorphic (67% versus 42% of EBV-positive). They are also more aggressive and more likely to require anti-neoplastic therapy along with reduced immunosuppression. Moreover, most PTLDs are B or T-cell clonal neoplasms and rarely plasma cell-rich entities.
Case Description
We present a unique case of a 53-year-old male with end-stage renal disease due to hypertensive nephrosclerosis who underwent deceased donor renal transplant with nadir serum creatinine (SCr) 1.6mg/dl. Perioperative course was uneventful. We used alemtuzumab induction with tacrolimus, mycophenolate mofetil, and corticosteroid maintenance therapy. Both donor and recipient were EBV seropositive.
After the first month, patient underwent renal biopsy for suboptimal renal function, which showed nonspecific changes. At month two, he developed BK viremia, so immunosuppression was reduced. SCr then increased to 2.2mg/dl, prompting another biopsy, which showed a clonal plasma cell neoplasm (A, B) with lambda light chain predominance (kappa/lambda 1:10) and a negative EBV-encoded RNA in situ hybridization (EBER). Bone marrow biopsy showed no sign of plasma cell disorder. Patient was diagnosed with renal-limited polymorphic PTLD and treated with further immunosuppression reduction only. Biopsy six weeks later showed normal kappa/lambda and near complete resolution of PTLD (C, D).
Discussion
This is a very unusual case in that our patient was EBER-negative with a plasma cell-rich PTLD, yet presented early post-transplant with a polymorphic PTLD and an excellent response to reduced immunosuppression alone.
Diffuse interstitial inflammation (A) with many plasma cells (B). Focal interstitial inflammation (C) with few plasma cells (D).