Document 0358
 DOCN  M9650358
 TI    Hodgkin's disease after transplantation.
 DT    9605
 AU    Garnier JL; Lebranchu Y; Dantal J; Bedrossian J; Cahen R; Assouline D;
       Jaccard A; Fetissoff F; Moreau A; Martin X; Delsol G; Berger F; Touraine
       JL; Inserm U80, Service d'Urologie, Departement d' Hematologie,; Hopital
       Edouard Herriot, Lyon, France.
 SO    Transplantation. 1996 Jan 15;61(1):71-6. Unique Identifier : AIDSLINE
       MED/96144871
 AB    Hodgkin's disease (HD) has seldom been reported after transplantation.
       Epstein-Barr virus (EBV) is present in about 50% of Reed-Sternberg cells
       in HD developing in immunocompetent individuals, but is more frequently
       found in HD of acquired immune deficiency syndrome patients. We report 7
       cases of HD that occurred in transplant recipients. Clinical and
       pathological data and studies of EBV reveal specific features of HD
       after transplantation. Six patients received kidney transplants and 1
       patient received combined kidney and pancreas transplantation.
       Immunosuppressive therapy consisted of cyclosporine, steroids,
       azathioprine, and antilymphocyte globulins. One patient received, in
       addition, anti-CD3 mAb therapy and an EBV+ B cell lymphoma developed.
       Retrospective EBV serological data from patients were collected. Tumors
       were classified according to pathology. EBV studies were conducted by
       immunohistochemical methods with monoclonal antibodies to EBV-latent
       membrane protein (LMP) or EBV-nuclear antigen 2 (EBNA2), and by in situ
       hybridization for latent nuclear EBV-early RNAs (EBERs). The mean lapse
       of time between transplantation and HD was 49 months. Six patients
       presented with enlarged lymph nodes and 1 patient presented with liver
       involvement. HD was classified as IA in 2 patients, IIA in 3 patients,
       IIIB in 1 patient, and IVB in 1 patient. Four patients had primary EBV
       infection after graft, before HD, and the others reactivated latent EBV
       infection. Histological subtypes were mixed cellularity in 6 cases and
       lymphocytic depletion in 1 case. Latent EBV infection was detected with
       EBERs in all tumors. Reed-Sternberg cells expressed LMP, and were
       negative for EBNA2 expression. Six patients were treated: 2 patients at
       stage I received radiotherapy, and relapsed within 1 year with a more
       advanced stage of HD; chemotherapy was indicated as primary therapy in 5
       patients, and as salvage therapy in 2 patients; it was associated with
       radiotherapy in 4 patients. Immunosuppressive therapy was reduced in all
       patients. Four patients were alive and in complete remission 18, 25, 31,
       and 67 months after chemotherapy, with a functioning graft in 3
       patients. Two patients died of infection. Mixed cellularity is the most
       frequent histological subtype observed in HD occurring in transplant
       patients. EBV is present in all Reed-Sternberg cells. Posttransplant HD
       shows similarities with human immunodeficiency virus-associated HD.
       These facts argue for a role of EBV infection and immunosuppression in
       the progression of HD after transplantation.
 DE    Adolescence  Adult  Graft Rejection/PREVENTION & CONTROL  Herpesvirus 4,
       Human/ISOLATION & PURIF  Hodgkin's
       Disease/*ETIOLOGY/PHYSIOPATHOLOGY/VIROLOGY  Human  Immunosuppressive
       Agents/ADVERSE EFFECTS  Kidney Transplantation/*ADVERSE EFFECTS
       Lymphoma, B-Cell/ETIOLOGY/PHYSIOPATHOLOGY/VIROLOGY  Male  Middle Age
       Pancreas Transplantation/*ADVERSE EFFECTS  Support, Non-U.S. Gov't
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).