Post-transplant hepatosplenic T-cell lymphoma successfully treated with HyperCVAD regimen

Am J Hematol. 2008 Apr;83(4):330-3. doi: 10.1002/ajh.21062.

Abstract

Hepatosplenic T-cell lymphoma (HSTL) is an aggressive lymphoma. In post-transplant immunosuppressed patients, HSTL is usually rapidly fatal. We report successful treatment of post-transplant HSTL in a 50-year-old renal allograft recipient by reducing immunosuppression and using intensive chemotherapy consisting of alternating cycles of HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and MTX/HiDAC (methotrexate, Ara-C). Remission is ongoing at 8+ years. Literature review identified another 20 cases of HSTL in solid organ transplant recipients: median survival was 4 months; no other patients survived beyond 12 months. Bone marrow involvement was universal, but changes were often subtle: 6 of 12 cases had nondiagnostic examinations earlier on. High index of suspicion may lead to more timely diagnosis of this uncommon form of post-transplant lymphoproliferative disorder, and treatment with intensive chemotherapy such as HyperCVAD may be curative.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bone Marrow / pathology
  • Carcinoma, Transitional Cell / surgery
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Kidney Transplantation
  • Liver Neoplasms / drug therapy*
  • Liver Neoplasms / etiology
  • Liver Neoplasms / pathology
  • Lymphoma, T-Cell / drug therapy*
  • Lymphoma, T-Cell / etiology
  • Lymphoma, T-Cell / pathology
  • Methotrexate / administration & dosage
  • Middle Aged
  • Neoplasms, Second Primary / drug therapy*
  • Neoplasms, Second Primary / etiology
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Receptors, Antigen, T-Cell, gamma-delta / analysis
  • Remission Induction
  • Splenic Neoplasms / drug therapy*
  • Splenic Neoplasms / etiology
  • Splenic Neoplasms / pathology
  • Urinary Bladder Neoplasms / surgery
  • Vesico-Ureteral Reflux / surgery
  • Vincristine / administration & dosage

Substances

  • Receptors, Antigen, T-Cell, gamma-delta
  • Cytarabine
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Methotrexate

Supplementary concepts

  • CVAD protocol