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• W2028067964 abstract "In a recent article published in Cancer, Cavaliere et al presented the results of a retrospective, multicentric International Primary Central Nervous System Lymphoma Collaborative Group report on the characteristics and outcome of 34 solid organ transplantation patients presenting with primary central nervous system post-transplantation lymphoproliferative disorder (PCNS-PTLD).1 We recently reviewed all transplantation patients who were diagnosed with PTLD after transplantation in our center over the last 20 years (1989-2009). Of the 116 (±2% of the transplantation population) PTLD cases that were identified, 5 (4.3%) patients presented with isolated central nervous system involvement (4 patients after kidney transplantation and 1 patient after lung transplantation). These 5 cases of PCNS-PTLD correspond to 7.9% of the total of 63 cases of PCNSL identified over the same period. The median ages of the patients at the time of transplantation (49 years; range, 42-55 years) and diagnosis (61 years; range, 43-74 years) were higher than in the series by Cavaliere et al.1 The interval between transplantation and diagnosis of PCNS-PTLD was >10 years in 3 patients, and was <1 year in 1 patient. The histological subtype was monomorphic (diffuse large B-cell lymphoma) in 4 patients, 3 of whom demonstrated positivity for the Epstein-Barr virus on in situ hybridization. After transplantation, only 1 transplantation recipient (lung) received induction therapy with antithymocyte globulin. Maintenance immunosuppression was comprised of combinations of mycophenolate mofetil (4 patients), calcineurin inhibitors (3 patients), and low-dose corticosteroids (4 patients). At the time of diagnosis, lactate dehydrogenase was found to be elevated in 2 (40%) patients. All patients were treated with reduction of immunosuppression (RIS), whereas chemotherapy was added in 3 patients and high-dose corticosteroids in 2 patients. Only 1 patient was treated with RIS alone. After initial treatment, 1 patient (treated with RIS only) achieved a complete remission (CR), 2 patients achieved a partial remission (PR), and 1 patient had stable disease, whereas the last patient died during induction therapy. One of the patients with a PR achieved a lasting CR after radiotherapy. During follow-up, 3 patients died within the first 3 months after diagnosis. Similar to the findings of Cavaliere et al,1 a subset of patients fared well, with 1 patient in CR dying 47 months after diagnosis because of an unrelated problem and another patient in CR still alive without signs of disease recurrence at a follow-up of 25 months. No graft loss was observed in these patients. Although we realize that no firm conclusions can be made based on this small patient population, we believe our analysis gives an idea of the incidence of PCNS-PTLD in both PTLD and PCNSL populations. Despite aggressive presentation, a subset of patients respond well to initial treatment with favorable long-term outcomes, comparable to PCNSL diagnosed in immunocompetent patients.2" @default.
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• W2028067964 date "2010-04-27" @default.
• W2028067964 modified "2023-10-12" @default.
• W2028067964 title "Primary central nervous system post-transplantation lymphoproliferative disorder" @default.
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• W2028067964 doi "https://doi.org/10.1002/cncr.25340" @default.
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