Korean J Hematol.  2009 Dec;44(4):278-283. 10.5045/kjh.2009.44.4.278.

Hodgkin's Lymphoma-like Posttransplantation Lymphoproliferative Disorder after Allogeneic Hematopoietic Stem Cell Transplantation

• Lee SM
• Kim KH
• Kang MJ
• Choi MY
• Lee WS
• Joo YD

• KMID: 2252110
• DOI: http://doi.org/10.5045/kjh.2009.44.4.278

Abstract

Hematopoietic stem cell transplantation (HSCT) recipients have a risk of post-transplant lymphoproliferative disorder (PTLD), which normally develops in Epstein-Barr virus (EBV) transformed donor B lymphocytes. The incidence of Hodgkin's lymphoma (HL) ranges from 1.8% to 3.4% of PTLD after HSCT. There are no case reports of early onset HL-like PTLD that developed less than one year after HSCT. We encountered a case of early onset PTLD after an unrelated HSCT following reduced-intensity conditioning with cyclophosphamide/fludarabine/thymoglobulin. A 24 year old patient with severe aplastic anemia developed multiple lymphadenopathies at day 95 after HSCT. The excisional biopsy revealed HL-like PTLD, which tested positive to immunohistochemical staining for the EBV. The Ann Arbor stage was IIA. Immunosuppressive agents were discontinued for 2 weeks in order to induce a graft-versus-lymphoma effect without a response. A total 4 cycles of chemotherapy with doxorubicin (adriamycin)/bleomycin/ vinblastine/dacarbazine (ABVD) and radiotherapy (total dosage 3,400 cGy) were then carried out. The response to salvage treatment was complete remission. The patient showed no evidence of the disease at the follow-up performed 32 months after HSCT.

Keyword

Posttransplant lymphoproliferative disorder; Hodgkin's lymphoma; Hematopoietic stem cell transplantation

MeSH Terms

Anemia, Aplastic
B-Lymphocytes
Biopsy
Doxorubicin
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Herpesvirus 4, Human
Hodgkin Disease
Humans
Immunosuppressive Agents
Incidence
Lymphoproliferative Disorders
Tissue Donors
Doxorubicin
Immunosuppressive Agents

Figure

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  Fig. 1. Bone marrow finding at diagnosis of severe aplastic anemia (cellularity 10%, H&E stain, ×40).

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  Fig. 2. CT scan of neck at initial diagnosis of PTLD. Multiple enlarged cervical lymph nodes (arrows) with heterogeneous enhancement and relatively clear perinodal fat plane at both neck and lateral group of left retropharyngeal lymph node.

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  Fig. 3. Pathologic findings of neck lymph node biopsy. (A) B lymphocyte maturation with small lymphocyte, medium size lymphoid cell, plasma cell, and immunoblast (H&E stain). (B) RS cell-like atypical immunoblast (arrow) and atypical lymphoid cells (H&E stain). (C) Positive for EBV in situ hybridization. (D) Positive for CD20 stain (B lymphocyte marker) within small lymphocyte, Reed Sternberg cell-like immunoblast and atypical lymphoid cells. (E) Positive for CD30 stain. (F) Negative for CD15 stain.

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  Fig. 4. Bone marrow finding at diagnosis of PTLD (Cellularity 50∼60%, H&E stain, ×40). The maturation sequence of myeloid and erythroid series is normal. Lymphoid cells are decreased and most cells are small mature forms.

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  Fig. 5. PET-CT at initial diagnosis of PTLD. High metabolic lesions in both retropharyngeal spaces and both cervical lymph nodes (right II, III, left II, III and IV).

Reference

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