Primary central nervous system post-transplantation lymphoproliferative disorder

An international primary central nervous system lymphoma collaborative group report

Robert Cavaliere, Gina Petroni, Maria B. Lopes, David Schiff, Brian P. O'Neill, Scott R. Plotkin, Gustaaf W. Van Imhoff, Edward Neuwelt, Kristoph Jahnke, Jeffrey J. Raizer, J. Lee Villano, Lauren E. Abrey, Tracy T. Batchelor, Gerald Illerhaus, Sandra J. Horning

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

BACKGROUND: Primary central nervous system (CNS) post-transplantation lymphoproliferative disorder (PCNSPTLD) is a rare complication of solid organ transplantation. The objectives of this study were to define the clinical, radiologic, and pathologic features of this disease and to explore the impact of treatment on patient outcomes. METHODS: The authors reviewed the databases of participating institutions of the International Primary CNS Lymphoma Collaborative Group for cases of PCNS-PTLD. Thirty-four patients who had pathologically confirmed PCNS-PTLD without evidence of systemic PTLD were investigated retrospectively. RESULTS: The median time from transplantation to diagnosis of PCNS-PTLD was 4.4 years. Disease usually was multifocal and involved any location of the brain but was most common in the cerebral hemispheres, usually in the subcortical white matter or basal ganglia. Radiographically, all lesions enhanced either homogenously or in a ring-enhancing pattern. Cerebral biopsy was required to establish diagnosis in most patients. Most patients had monomorphic, Epstein-Barr virus (EBV)-positive disease of B-cell origin. Response rates were high regardless of treatment type, and the median survival was 47 months. Age was the only factor predictive of survival. CONCLUSIONS: The current study demonstrated that PCNS-PTLD is typically an EBVinduced B-cell lymphoma that is responsive to treatment with favorable survival in many patients. An aggressive approach to tissue confirmation of diagnosis and treatment with chemotherapy or radiotherapy should be strongly considered.

Original languageEnglish (US)
Pages (from-to)863-870
Number of pages8
JournalCancer
Volume116
Issue number4
DOIs
StatePublished - Feb 15 2010
Externally publishedYes

Fingerprint

Lymphoproliferative Disorders
Lymphoma
Central Nervous System
Transplantation
Survival
Cerebrum
Organ Transplantation
B-Cell Lymphoma
Virus Diseases
Therapeutics
Basal Ganglia
Human Herpesvirus 4
B-Lymphocytes
Radiotherapy
Databases
Biopsy
Drug Therapy
Brain

Keywords

  • Central nervous system
  • Lymphoma
  • Post-transplantation lymphoproliferative disorder
  • Rituximab
  • Transplantation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Primary central nervous system post-transplantation lymphoproliferative disorder : An international primary central nervous system lymphoma collaborative group report. / Cavaliere, Robert; Petroni, Gina; Lopes, Maria B.; Schiff, David; O'Neill, Brian P.; Plotkin, Scott R.; Van Imhoff, Gustaaf W.; Neuwelt, Edward; Jahnke, Kristoph; Raizer, Jeffrey J.; Villano, J. Lee; Abrey, Lauren E.; Batchelor, Tracy T.; Illerhaus, Gerald; Horning, Sandra J.

In: Cancer, Vol. 116, No. 4, 15.02.2010, p. 863-870.

Research output: Contribution to journalArticle

Cavaliere, R, Petroni, G, Lopes, MB, Schiff, D, O'Neill, BP, Plotkin, SR, Van Imhoff, GW, Neuwelt, E, Jahnke, K, Raizer, JJ, Villano, JL, Abrey, LE, Batchelor, TT, Illerhaus, G & Horning, SJ 2010, 'Primary central nervous system post-transplantation lymphoproliferative disorder: An international primary central nervous system lymphoma collaborative group report', Cancer, vol. 116, no. 4, pp. 863-870. https://doi.org/10.1002/cncr.24834
Cavaliere, Robert ; Petroni, Gina ; Lopes, Maria B. ; Schiff, David ; O'Neill, Brian P. ; Plotkin, Scott R. ; Van Imhoff, Gustaaf W. ; Neuwelt, Edward ; Jahnke, Kristoph ; Raizer, Jeffrey J. ; Villano, J. Lee ; Abrey, Lauren E. ; Batchelor, Tracy T. ; Illerhaus, Gerald ; Horning, Sandra J. / Primary central nervous system post-transplantation lymphoproliferative disorder : An international primary central nervous system lymphoma collaborative group report. In: Cancer. 2010 ; Vol. 116, No. 4. pp. 863-870.
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T2 - An international primary central nervous system lymphoma collaborative group report

AU - Cavaliere, Robert

AU - Petroni, Gina

AU - Lopes, Maria B.

AU - Schiff, David

AU - O'Neill, Brian P.

AU - Plotkin, Scott R.

AU - Van Imhoff, Gustaaf W.

AU - Neuwelt, Edward

AU - Jahnke, Kristoph

AU - Raizer, Jeffrey J.

AU - Villano, J. Lee

AU - Abrey, Lauren E.

AU - Batchelor, Tracy T.

AU - Illerhaus, Gerald

AU - Horning, Sandra J.

PY - 2010/2/15

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N2 - BACKGROUND: Primary central nervous system (CNS) post-transplantation lymphoproliferative disorder (PCNSPTLD) is a rare complication of solid organ transplantation. The objectives of this study were to define the clinical, radiologic, and pathologic features of this disease and to explore the impact of treatment on patient outcomes. METHODS: The authors reviewed the databases of participating institutions of the International Primary CNS Lymphoma Collaborative Group for cases of PCNS-PTLD. Thirty-four patients who had pathologically confirmed PCNS-PTLD without evidence of systemic PTLD were investigated retrospectively. RESULTS: The median time from transplantation to diagnosis of PCNS-PTLD was 4.4 years. Disease usually was multifocal and involved any location of the brain but was most common in the cerebral hemispheres, usually in the subcortical white matter or basal ganglia. Radiographically, all lesions enhanced either homogenously or in a ring-enhancing pattern. Cerebral biopsy was required to establish diagnosis in most patients. Most patients had monomorphic, Epstein-Barr virus (EBV)-positive disease of B-cell origin. Response rates were high regardless of treatment type, and the median survival was 47 months. Age was the only factor predictive of survival. CONCLUSIONS: The current study demonstrated that PCNS-PTLD is typically an EBVinduced B-cell lymphoma that is responsive to treatment with favorable survival in many patients. An aggressive approach to tissue confirmation of diagnosis and treatment with chemotherapy or radiotherapy should be strongly considered.

AB - BACKGROUND: Primary central nervous system (CNS) post-transplantation lymphoproliferative disorder (PCNSPTLD) is a rare complication of solid organ transplantation. The objectives of this study were to define the clinical, radiologic, and pathologic features of this disease and to explore the impact of treatment on patient outcomes. METHODS: The authors reviewed the databases of participating institutions of the International Primary CNS Lymphoma Collaborative Group for cases of PCNS-PTLD. Thirty-four patients who had pathologically confirmed PCNS-PTLD without evidence of systemic PTLD were investigated retrospectively. RESULTS: The median time from transplantation to diagnosis of PCNS-PTLD was 4.4 years. Disease usually was multifocal and involved any location of the brain but was most common in the cerebral hemispheres, usually in the subcortical white matter or basal ganglia. Radiographically, all lesions enhanced either homogenously or in a ring-enhancing pattern. Cerebral biopsy was required to establish diagnosis in most patients. Most patients had monomorphic, Epstein-Barr virus (EBV)-positive disease of B-cell origin. Response rates were high regardless of treatment type, and the median survival was 47 months. Age was the only factor predictive of survival. CONCLUSIONS: The current study demonstrated that PCNS-PTLD is typically an EBVinduced B-cell lymphoma that is responsive to treatment with favorable survival in many patients. An aggressive approach to tissue confirmation of diagnosis and treatment with chemotherapy or radiotherapy should be strongly considered.

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KW - Lymphoma

KW - Post-transplantation lymphoproliferative disorder

KW - Rituximab

KW - Transplantation

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