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Strahlentherapie und Onkologie

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01-01-2017 | Case Study

Post-transplant lymphoproliferative disorder in the pelvis successfully treated with consolidative radiotherapy

Authors: Omar Habibeh, Khaled Elsayad, Jan Kriz, Uwe Haverkamp, Hans Theodor Eich

Published in: Strahlentherapie und Onkologie | Issue 1/2017

Abstract

Background

Post-transplant lymphoproliferative disorders (PTLDs) are aggressive malignancies which represent one of the major post-transplant complications. However, treatment options vary significantly and localized disease may be curatively treated with radiotherapy (RT) or surgery. We report a case of recurrent rectal PTLD, which was successfully treated by chemoimmunotherapy followed by RT.

Case presentation

We describe a patient who developed a rectal lymphoproliferative lesion 11 years after kidney transplant, which was successfully treated with consolidative RT using 25.4 Gy sequential to chemoimmunotherapy (R-CHOP). RT was well tolerated and the patient showed no signs of grade 3 or 4 toxicity. This patient is free of recurrence 52 months after RT, with an overall survival of 62 months since diagnosis.

Conclusion

Conventionally fractionated moderate-dose RT appears to be a tolerable and effective treatment option for localized PTLD if a sufficient systemic treatment cannot be applied.

Taylor AL, Marcus R, Bradley JA (2005) Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 56(1):155–167. doi:10.1016/j.critrevonc.2005.03.015 CrossRefPubMed

Mucha K, Foroncewicz B, Ziarkiewicz-Wróblewska B et al (2010) Post-transplant lymphoproliferative disorder in view of the new WHO classification: a more rational approach to a protean disease? Nephrol Dial Transplant 25(7):2089–2098. doi:10.1093/ndt/gfq231 CrossRefPubMed

Nalesnik MA, Jaffe R, Starzl TE et al (1988) The pathology of posttransplant lymphoproliferative disorders occurring in the setting of cyclosporine A‑prednisone immunosuppression. Am J Pathol 133(1):173–192PubMedPubMedCentral

Jagadeesh D, Woda BA, Draper J et al (2012) Post transplant Lymphoproliferative disorders: Risk, classification, and therapeutic recommendations. Curr Treat Options Oncol 13(1):122–136. doi:10.1007/s11864-011-0177-x CrossRefPubMed

Timms JM, Bell A, Flavell JR et al (2003) Target cells of Epstein-Barr-Virus (EBV)-positive post-transplant lymphoproliferative disease: Similarities to EBV-positive Hodgkin’s lymphoma. Lancet 361(9353):217–223. doi:10.1016/S0140-6736(03)12271-4 CrossRefPubMed

Parker A, Bowles K, Bradley JA et al (2010) Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients – BCSH and BTS Guidelines. Br J Haematol 149(5):693–705. doi:10.1111/j.1365-2141.2010.08160.x CrossRefPubMed

Koffman BH, Kennedy AS, Heyman M et al (2000) Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation. Int J Cancer 90(2):104–109CrossRefPubMed

Yahalom J, Illidge T, Specht L et al (2015) Modern radiation therapy for Extranodal lymphomas. field and dose guidelines from the international Lymphoma radiation oncology group. Int J Radiat Oncol 92(1):11–31. doi:10.1016/j.ijrobp.2015.01.009 CrossRef

Campo E, Swerdlow SH, Harris NL et al (2011) The 2008 WHO classification of lymphoid neoplasms and beyond: Evolving concepts and practical applications. Blood 117(19):5019–5032. doi:10.1182/blood-2011-01-293050 CrossRefPubMedPubMedCentral

10.

Parker A, Bowles K, Bradley JA et al (2010) Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients – BCSH and BTS Guidelines. Br J Haematol 149(5):675–692. doi:10.1111/j.1365-2141.2010.08161.x CrossRefPubMed

11.

Jagadeesh D, Hooda S, Fenner KB et al (2014). Post Transplant Lymphoproliferative Disorders (PTLD) after Solid Organ Transplant: Cleveland Clinic Experience. Blood 124(21), 3008. Retrieved from http://www.bloodjournal.org/content/124/21/3008. Accessed 20 June 2016.

12.

Jacobsen ED, Sharman JP, Oki Y et al (2015) Brentuximab vedotin demonstrates objective responses in a phase 2 study of relapsed/refractory DLBCL with variable CD30 expression. Blood. 2015 Feb 26;125(9):1394-402. doi: 10.1182/blood-2014-09-598763.

13.

Izadi M, Fazel M, Saadat SH et al (2011) Radiotherapy is the best treatment method in post transplant lymphoproliferative disorders localizing in brain: a review of the literature. Annals of transplantation : quarterly of the Polish Transplantation. Society 16(4):126–133

14.

Henkenberens C, Franzke A, Raab P et al (2014) Primary EBV-positive Hodgkin’s lymphoma of the CNS under azathioprine treatment. Strahlenther Onkol 190(9):847–852. doi:10.1007/s00066-014-0670-9 CrossRefPubMed

15.

Buell JF, Gross TG, Hanaway MJ et al (2005) Posttransplant Lymphoproliferative disorder. Significance of central nervous system involvement. Transplant Proc 37(2):954–955. doi:10.1016/j.transproceed.2004.12.130 CrossRefPubMed

16.

Dotti G, Fiocchi R, Motta T et al (2002) Lymphomas occurring late after solid-organ transplantation – Influence of treatment on the clinical outcome. Transplantation 74(8):1095–1102CrossRefPubMed

17.

Koffman BH, Kennedy AS, Heyman M et al (2000) Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation. Int J Cancer 90(2):104–109CrossRefPubMed

18.

Corn BW, Donahue BR, Rosenstock JG et al (1997) Palliation of AIDS-related primary lymphoma of the brain: observations from a multi-institutional database. Int J Radiat Oncol Biol Phys 38(3):601–605CrossRefPubMed

19.

Lowry L, Smith P, Qian W et al (2011) Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: a randomised phase III trial. Radiotherapy and oncology. Radiol Oncol 100(1):86–92. doi:10.1016/j.radonc.2011.05.013 CrossRef

20.

Elsayad K, Kriz J, Moustakis C et al (2015) Total skin electron beam for primary cutaneous T‑cell lymphoma. Int J Radiat Oncol Biol Phys 93(5):1077–1086. doi:10.1016/j.ijrobp.2015.08.041 CrossRefPubMed

21.

Akhtari M, Reddy JP, Pinnix CC et al (2016) Primary cutaneous B‑cell lymphoma (non-leg type) has excellent outcomes even after very low dose radiation as single-modality therapy. Leuk Lymphoma 57(1):34–38. doi:10.3109/10428194.2015.1040012 CrossRefPubMed

22.

Fakhrian K, Klemm S, Keller U et al (2013) Radiotherapy in stage I‑III follicular non-Hodgkin lymphoma. Retrospective analysis of a series of 50 patients. Strahlenther Onkol 189(2):168 doi:10.1007/s00066-012-0279-9 CrossRef

23.

Vargo JA, Gill BS, Balasubramani GK et al (2015) Treatment selection and survival outcomes in early-stage diffuse large B‑cell lymphoma: Do we still need consolidative radiotherapy? J Clin Oncol 33(32):3710 doi:10.1200/JCO.2015.61.7654 CrossRefPubMed

24.

Nieder C (2016) Ist beim diffus großzelligen B‑Zell-Lymphom im frühen Stadium nach der Chemotherapie eine konsolidierende Strahlentherapie erforderlich? Strahlenther Onkol doi:10.1007/s00066-016-0967-y

25.

Elsayad K, Eich HT (2016) Überlebensvorteil durch konsolidierende Strahlentherapie bei Patienten mit diffusem großzelligen B-Zell-Lymphom in den Frühstadien. Strahlenther Onkol doi:10.1007/s00066-016-0992-x

26.

Hernando-Requejo O, Lopez M, Cubillo A et al (2014) Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation. Strahlenther Onkol 190(6):515–520. doi: 10.1007/s00066-014-0650-0 CrossRefPubMed

27.

Tsai DE, Stadtmauer EA, Canaday DJ et al (1998) Combined radiation and chemotherapy in posttransplant lymphoproliferative disorder. Med Oncol 15(4):279-81. doi: 10.1007/BF02787213

28.

Karuturi M, Shah N, Frank D et al (2013) Plasmacytic post-transplant lymphoproliferative disorder: a case series of nine patients. Transpl Int. 26(6):616-22. doi: 10.1111/tri.12091

Title: Post-transplant lymphoproliferative disorder in the pelvis successfully treated with consolidative radiotherapy
Authors: Omar Habibeh
Khaled Elsayad
Jan Kriz
Uwe Haverkamp
Hans Theodor Eich
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 1/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-1006-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Post-transplant lymphoproliferative disorder in the pelvis successfully treated with consolidative radiotherapy

Abstract

Background

Case presentation

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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