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Clinical Investigations: LUNG TRANSPLANTATION |

Posttransplant Lymphoproliferative Disorder*: Incidence, Presentation, and Response to Treatment in Lung Transplant Recipients

B. Diane Reams; H. Page McAdams; David N. Howell; Mark P. Steele; R. Duane Davis; Scott M. Palmer
Author and Funding Information

*From the Departments of Pharmacy (Dr. Reams), Radiology (Dr. McAdams), and Pathology (Dr. Howell); Division of Pulmonary and Critical Care Medicine (Drs. Steele and Palmer), Department of Medicine; and Division of Cardiothoracic Surgery (Dr. Davis), Department of Surgery, Duke University Medical Center, Durham, NC.

Correspondence to: Scott M. Palmer, MD, MHS, FCCP, Medical Director, Lung Transplantation Program, Box 3876, Duke University Medical Center, Durham, NC 27710; e-mail: Palme002@mc. duke.edu



Chest. 2003;124(4):1242-1249. doi:10.1378/chest.124.4.1242
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Introduction: Posttransplant lymphoproliferative disorder (PTLD) is a relatively infrequent but devastating complication that occurs after solid-organ transplantation. Although the optimal treatment for this condition is unknown, rituximab, a murine/human chimeric monoclonal antibody, has shown promise in the treatment of PTLD. In this report, we define the incidence, clinical features at presentation, and response to treatment of all cases of PTLD observed at our institution over a 10-year period, including four patients who received treatment with rituximab.

Methods: A review of all patients who underwent lung or heart-lung transplant at Duke University from 1992 to 2002 was performed (n = 400), and demographic and clinical outcome data were extracted.

Results: PTLD was observed in 10 of 400 patients (2.5%). Patients who acquired PTLD were predominately > 55 years old (8 of 10 patients) and with a native disease of COPD (7 of 10 patients). Diagnosis of PTLD was made a median of 343 days after transplant. The type of transplant and Epstein-Barr virus (EBV) status prior to transplant did not appear to influence the risk for PTLD. Patients presented with thoracic organ involvement (7 of 10 patients), extrapulmonary disease (2 of 10 patients), or both (1 of 10 patients). Histologic subtypes included polymorphic B cell (n = 4), monomorphic B cell (n = 3), B cell without further classification (n = 2), and anaplastic T cell (n = 1). Only one patient responded to reduced immunosuppression alone. Patients treated with surgery or radiation (n = 2) or rituximab (n = 4) had favorable responses to therapy. Both patients treated with chemotherapy died related to complications of treatment and PTLD.

Conclusions: Presentation and histologic appearance of PTLD varies considerably among lung transplant recipients. PTLD was more frequent among older patients with COPD, regardless of pretransplant EBV serology. Rituximab appears effective as a first-line therapy for PTLD, but additional studies are needed in order to define its efficacy and side effect profile in this population of patients.

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