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1996-03-09
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Document 0358
DOCN M9650358
TI Hodgkin's disease after transplantation.
DT 9605
AU Garnier JL; Lebranchu Y; Dantal J; Bedrossian J; Cahen R; Assouline D;
Jaccard A; Fetissoff F; Moreau A; Martin X; Delsol G; Berger F; Touraine
JL; Inserm U80, Service d'Urologie, Departement d' Hematologie,; Hopital
Edouard Herriot, Lyon, France.
SO Transplantation. 1996 Jan 15;61(1):71-6. Unique Identifier : AIDSLINE
MED/96144871
AB Hodgkin's disease (HD) has seldom been reported after transplantation.
Epstein-Barr virus (EBV) is present in about 50% of Reed-Sternberg cells
in HD developing in immunocompetent individuals, but is more frequently
found in HD of acquired immune deficiency syndrome patients. We report 7
cases of HD that occurred in transplant recipients. Clinical and
pathological data and studies of EBV reveal specific features of HD
after transplantation. Six patients received kidney transplants and 1
patient received combined kidney and pancreas transplantation.
Immunosuppressive therapy consisted of cyclosporine, steroids,
azathioprine, and antilymphocyte globulins. One patient received, in
addition, anti-CD3 mAb therapy and an EBV+ B cell lymphoma developed.
Retrospective EBV serological data from patients were collected. Tumors
were classified according to pathology. EBV studies were conducted by
immunohistochemical methods with monoclonal antibodies to EBV-latent
membrane protein (LMP) or EBV-nuclear antigen 2 (EBNA2), and by in situ
hybridization for latent nuclear EBV-early RNAs (EBERs). The mean lapse
of time between transplantation and HD was 49 months. Six patients
presented with enlarged lymph nodes and 1 patient presented with liver
involvement. HD was classified as IA in 2 patients, IIA in 3 patients,
IIIB in 1 patient, and IVB in 1 patient. Four patients had primary EBV
infection after graft, before HD, and the others reactivated latent EBV
infection. Histological subtypes were mixed cellularity in 6 cases and
lymphocytic depletion in 1 case. Latent EBV infection was detected with
EBERs in all tumors. Reed-Sternberg cells expressed LMP, and were
negative for EBNA2 expression. Six patients were treated: 2 patients at
stage I received radiotherapy, and relapsed within 1 year with a more
advanced stage of HD; chemotherapy was indicated as primary therapy in 5
patients, and as salvage therapy in 2 patients; it was associated with
radiotherapy in 4 patients. Immunosuppressive therapy was reduced in all
patients. Four patients were alive and in complete remission 18, 25, 31,
and 67 months after chemotherapy, with a functioning graft in 3
patients. Two patients died of infection. Mixed cellularity is the most
frequent histological subtype observed in HD occurring in transplant
patients. EBV is present in all Reed-Sternberg cells. Posttransplant HD
shows similarities with human immunodeficiency virus-associated HD.
These facts argue for a role of EBV infection and immunosuppression in
the progression of HD after transplantation.
DE Adolescence Adult Graft Rejection/PREVENTION & CONTROL Herpesvirus 4,
Human/ISOLATION & PURIF Hodgkin's
Disease/*ETIOLOGY/PHYSIOPATHOLOGY/VIROLOGY Human Immunosuppressive
Agents/ADVERSE EFFECTS Kidney Transplantation/*ADVERSE EFFECTS
Lymphoma, B-Cell/ETIOLOGY/PHYSIOPATHOLOGY/VIROLOGY Male Middle Age
Pancreas Transplantation/*ADVERSE EFFECTS Support, Non-U.S. Gov't
JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).