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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 6  |  Page : 1290-1292
Burkitt's lymphoma developing post liver transplantation: Posttransplant lymphoproliferative disorders international survey


1 Baqiyatallah Research Center for Gastroenterology and Liver Disease; Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Dr. Taheri Medical Research Group, Tehran, Iran

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Date of Web Publication10-Nov-2014
 

How to cite this article:
Khedmat H, Ghamar-Chehreh ME, Amini M, Taheri S. Burkitt's lymphoma developing post liver transplantation: Posttransplant lymphoproliferative disorders international survey. Saudi J Kidney Dis Transpl 2014;25:1290-2

How to cite this URL:
Khedmat H, Ghamar-Chehreh ME, Amini M, Taheri S. Burkitt's lymphoma developing post liver transplantation: Posttransplant lymphoproliferative disorders international survey. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2020 May 29];25:1290-2. Available from: http://www.sjkdt.org/text.asp?2014/25/6/1290/144270
To the Editor,

Posttransplant lymphoproliferative disorders (PTLD) in liver transplant recipients are repor­tedly about one to two. [1] Burkitt's lymphoma in non-transplant patients has been reportedly associated with a poor prognosis, and its diag­nosis usually necessitates chemotherapy of increasing intensity according to the disease stage. The typical presentation involves ra­pidly growing and multifocal extra-nodal mas­ses throughout the body. [2],[3],[4] We gathered data of all individual cases of Burkitt's lymphoma reported by the published series in English literature, in order to standardize the data and find associations of Burkitt's lymphoma deve­loping in liver transplant patients.

The study population consisted of 125 liver allograft recipients, who had developed PTLD in their post transplantation period. Histo-pathological evaluation confirmed PTLD of Burkitt's lymphoma type in 32 (25.6%) of the study participants, and the remaining 93 (74. 4%) had other types of PTLD. The data were gathered from 18 studies [5],[6],[7],[8],[9],[10],[11] and references 11, 16, 20, 25, 28, 45, 46, 50 from [12] and 43, 50, 51 from [13] have been included into a database and analyzed.

There were 50 (55.6%) males and 40 (44.4%) female patients (35 unreported). The mean age at diagnosis of PTLD was 21.9 ± 21.9 years (no unreported data; 125 cases). The mean interval between transplantation and the diag­nosis of PTLD was 46.7 ± 51.5 months (for 89 patients), whereas, the follow-up time after diagnosis of PTLD was 42.8 ± 46.8 months (for 101 patients). The characteristics of the pa­tients regarding their malignancy sites are summarized in [Table 1]. Burkitt's lymphoma was equally prevalent among males and females (P = 0.82) and different age groups (P = 0.68). The Epstein-Barr virus (EBV) infec­tion rates were also comparable between the two groups (P = 0.252). Burkitt's lymphoma lesions were significantly more likely to mani­fest in the bone marrow (nine (33%) vs. seven (9%); P = 0.006); a weak predominated rate of CNS involvement was also seen, although the significance level was not achieved (three (11%) vs. two (2%); P = 0.09). Even as all lesions from Burkitt's PTLD were positive for BCL-6, this rate was 50% among the controls (P = 0.033).
Table 1: Characteristics of liver graft recipients based on their PTLD pathology.

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At the last follow-up, 58 (49.2%) patients were dead (seven were with unreported data). The survival analysis showed no significant difference in the outcome of PTLD liver recipients with and without Burkitt's disease (P = 0.341; [Figure 1]). Changing the outcome parameter to "death due to PTLD" did not change the result.
Figure 1: Survival curves of liver graft recipients developing PTLD with regard to their histological features

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In this study, we found that Burkitt's lymphoma developing in liver transplant recipients is more likely to present as late onset PTLD, with a higher rate of disseminated disease as well as a monomorphic histopathology. [13] Never­theless; we have not found a survival disparity between Burkitt's lymphoma and other PTLD types. However, post liver transplantation Burkitt's lymphoma significantly developed bone marrow metastases more frequently. [14]

Our study was associated with some limi­tations. First, the study subjects were gathered from different reports that might have had different approaches. On the other hand, our study represented the largest ever investigated population of Burkitt's lymphoma in liver graft recipients; it also found novel and helpful findings for the physicians to evaluate their patients for early diagnosis of metastasis, and treatment. In conclusion, this study showed that the liver allograft recipients developing Burkitt's lymphoma after transplantation are at a higher risk of bone marrow complication; thus we recom­mend that all newly diagnosed patients go for proper evaluations. Future prospective studies are required to confirm our findings.


   Acknowledgment Top


This study was supported by a grant from the Baqiyatallah University of Medical Sciences. No duplicated paper from data of this study has been published before, or is under consideration anywhere. No conflict of interest exists in this study.

 
   References Top

1.
Penn I. Post-transplant malignancy: The role of immunosuppression. Drug Saf 2000;23:101-13.  Back to cited text no. 1
    
2.
Pasquale MA, Weppler D, Smith J, et al. Burkitt's lymphoma variant of post-transplant lymphoproliferative disease (PTLD). Pathol Oncol Res 2002;8:105-8.  Back to cited text no. 2
    
3.
Khedmat H, Taheri S. Heart allograft involve­ment by posttransplant lymphoproliferative disorders: Report from the PTLD. Int Survey. Exp Clin Transplant 2011;9:258-64.  Back to cited text no. 3
    
4.
Khedmat H, Taheri S. CD20 Antigen Expres­sion by Lymphoproliferative Disorders after Kidney Transplant is Independently Associated with a Poor Outcome: PTLD. Int Survey. Exp Clin Transplant 2012;10:325-31.  Back to cited text no. 4
    
5.
Gong JZ, Stenzel TT, Bennett ER, et al. Burkitt lymphoma arising in organ transplant recipients: A clinicopathologic study of five cases. Am J Surg Pathol 2003;27:818-27.  Back to cited text no. 5
    
6.
Picarsic J, Jaffe R, Mazariegos G, et al. Post-transplant Burkitt lymphoma is a more aggres­sive and distinct form of post-transplant lymphoproliferative disorder. Cancer 2011;117: 4540-50.  Back to cited text no. 6
    
7.
Zimmermann H, Reinke P, Neuhaus R, et al. Burkitt post-transplantation lymphoma in adult solid organ transplant recipients: Sequential immunochemotherapy with rituximab (R) fol­lowed by cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or R-CHOP is safe and effective in an analysis of 8 patients. Cancer 2012;118:4715-24.  Back to cited text no. 7
    
8.
Craig FE, Gulley ML, Banks PM. Post-trans­plantation lymphoproliferative disorders. Am J Clin Pathol 1993;99:265-76.  Back to cited text no. 8
    
9.
Oertel SH, Verschuuren E, Reinke P, et al. Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant 2005; 5:2901-6.  Back to cited text no. 9
    
10.
Niedobitek G, Mutimer DJ, Williams A, et al. Epstein-Barr virus infection and malignant lymphomas in liver transplant recipients. Int J Cancer 1997;73:514-20.  Back to cited text no. 10
    
11.
Koh BY, Rosenthal P, Medeiros LJ, Osorio RW, Roberts JP, Ascher NL, Gelb AB. Post-transplantation lymphoproliferative disorders in pediatric patients undergoing liver trans­plantation. Arch Pathol Lab Med 2001;125: 337-43.  Back to cited text no. 11
    
12.
Khedmat H, Taheri S. Lymphoproliferative disorders in pediatric liver allograft recipients: A review of 212 cases. Hematol Oncol Stem Cell Ther 2012;5:84-90.  Back to cited text no. 12
    
13.
Izadi M, Taheri S. Features, predictors and prognosis of lymphoproliferative disorders post-liver transplantation regarding disease presentation time: Report from the PTLD.Int. survey. Ann Transplant 2011;16:39-47.  Back to cited text no. 13
    
14.
Khedmat H, Taheri S. Bone marrow involve­ment by lymphoproliferative disorders post liver transplantation: PTLD Int Survey. Acta Med Indones 2012;44:207-13.  Back to cited text no. 14
    

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Correspondence Address:
Dr. Mohsen Amini
Baqiyatallah Research Center for Gastroenterology and Liver Disease; Baqiyatallah University of Medical Sciences, Tehran
Iran
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DOI: 10.4103/1319-2442.144270

PMID: 25394453

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