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Post-transplant Burkitt lymphoma is a more aggressive and distinct form of post-transplant lymphoproliferative disorder†
Article first published online: 28 MAR 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 19, pages 4540–4550, 1 October 2011
How to Cite
Picarsic, J., Jaffe, R., Mazariegos, G., Webber, S. A., Ellis, D., Green, M. D. and Reyes-Múgica, M. (2011), Post-transplant Burkitt lymphoma is a more aggressive and distinct form of post-transplant lymphoproliferative disorder. Cancer, 117: 4540–4550. doi: 10.1002/cncr.26001
We would like to thank Dr. Alejandro Best-Rocha; Dr. Fiona Craig, director of the University of Pittsburgh Medical Center Flow Cytometry Laboratory; Dr. Urvashi Surti, director of the Magee-Womens Hospital Cytogenetics Laboratory; and Ms. Lori Schmitt, pathology manager of the Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center, for all their help in this study.
- Issue published online: 16 SEP 2011
- Article first published online: 28 MAR 2011
- Manuscript Accepted: 14 JAN 2011
- Manuscript Revised: 12 JAN 2011
- Manuscript Received: 24 NOV 2010
- Burkitt lymphoma;
- Epstein-Barr virus;
- EBV PTLD;
- post-transplant lymphoproliferative disorder;
- pediatric transplant;
- pediatric oncology
Although the literature reports a low incidence of Burkitt lymphoma (BL) as a post-transplant lymphoproliferative disorder (PTLD), this entity appears to be different from other monomorphic PTLDs (M-PTLDs), both in its aggressive clinical presentation and its distinct pathologic profile.
Patients with BL, diagnosed in the post-transplant setting, (patients aged ≤18 years) were retrieved from the pathology archives at Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center from 1982 to 2010. Clinical outcomes were obtained along with pathologic review.
Twelve patients with pediatric BL in the post-transplant setting (9 boys, 3 girls) were retrieved. The patients displayed a monomorphic population of small to intermediate-sized, noncleaved, lymphoid elements with a “starry-sky” pattern. The immunophenotype for patients available to the study was CD20+ (n = 9/10), CD10+ (n = 8/8), bcl-6+ (n = 11/11), with a near 100% Ki-67/MIB-1 proliferation index (n = 7/7), and negative for TdT (n = 7/7). Most pretransplant Epstein-Barr virus titers were negative (n = 8/10), with post-transplant titers positive in all tested patients (n = 11), and with positive Epstein-Barr–encoded RNA in situ hybridization in most cases (n = 9/11). The median time from transplantation to diagnosis was 52 months (range, 6-107 months). Nine patients were currently alive after immediate antineoplastic chemotherapy, with median disease-free time of 93 months from diagnosis (range, 2-199 months).
BL-PTLD had a higher Epstein-Barr virus incidence compared with sporadic and immunodeficiency-associated BL and represented a distinct monomorphic PTLD. Although some M-PTLDs can be managed less aggressively with decreased immunosuppression alone, immediate lymphoma-specific chemotherapy was associated with a favorable outcome and was strongly recommended. Cancer 2011;. © 2011 American Cancer Society.