Malignant lymphoma in a renal transplant recipient treated with antithymocyte globulin

First report of a B cell lymphoproliferative disorder arising in a patient treated with immune suppressants for severe aplastic anemia

Aplastic anemia is a disorder characterized by pancytopenia and bone marrow hypocellularity. There is some evidence that aplastic anemia may be due to suppression of hematopoiesis by activated T-suppressor cells. Thus, immunosuppressive agents have been used as an alternative to bone marrow transplantation for treatment. We report on a unique case of a patient with aplastic anemia who was treated with a course of immunosuppression including cyclosporine (CSA), anti-thymocyte globulin (ATG), and prednisone. Five months after this treatment, the patient developed a B cell lymphoproliferative disorder which was successfully treated with radiation therapy. Prior reports of CSA-associated lymphoproliferative disorders have appeared in the literature as potential side effects of immunosuppression following transplantation. This is the first report of a lymphoproliferative disorder associated with immunosuppressive treatment of aplastic anemia in a nontransplant setting. Thus, when presenting options for treatment of aplastic anemia, lymphoproliferative disorders should be included as a rare complication of immunosuppressive therapy.

Passively acquired antibody directed at human erythrocytes seen during therapy with Minnesota antilymphoblast globulin

6 renal transplant patients, seen at the Mayo Clinic between July 1982 and April 1983, received Minnesota antilymphoblast globulin (MALG) for treatment of allograft rejection and demonstrated warm-acting 'auto'-antibodies during such therapy. These antibodies represented xenogeneic reactivity in equine MALG, rather than the products of patient-derived immune responses, since they were not detected before or after the period of therapy with this immunosuppressive agent in any of the 6 cases. They interfered with crossmatch procedures for red cell transfusion, and were only variably removed by autoabsorption techniques. Heat treatment of sera containing MALG-related red cell antibodies was ineffective in abrogating their reactivity and also compromised the reactivity of some red cell alloantibodies which were tested as controls. Transfusion of 'least-incompatible' red blood cells had no adverse effects in 2 cases where it was necessitated by clinical circumstances, despite an inability to obtain suitable serological samples for crossmatching.

Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy

Post-transplant lymphomas or other lymphoproliferative lesions, which were usually associated with Epstein-Barr virus infections, developed in 8, 4, 3, and 2 recipients, respectively, of cadaveric kidney, liver, heart, and heart-lung homografts. Reduction or discontinuance of immunosuppression caused regression of the lesions, often without subsequent rejection of the grafts. Chemotherapy and irradiation were not valuable. The findings may influence policies about treating other kinds of post-transplantation neoplasms.