Epstein-Barr virus associated post-transplant Hodgkin lymphoma in an adult patient after cord blood stem cell transplantation for acute lymphoblastic leukemia

Classical Hodgkin lymphoma-like post-transplant lymphoproliferative disease after allogeneic stem cell transplantation for primary myelofibrosis is successfully treated with nivolumab: A case report

Introduction

Post-transplant lymphoproliferative disease (PTLD), a lymphoid proliferation observed after the solid organ transplantation or allogeneic stem cell transplant, is an important and mortal complication that can occur during the post-transplant period. Classical Hodgkin lymphoma-like PTLD is the least form of PTLD. We are presenting an adult case of classical Hodgkin lymphoma-like PTLD which was successfully treated with nivolumab.

Case report

A 31-year-old female was diagnosed with primary myelofibrosis and we performed allogeneic stem cell transplantation from her HLA fully matched brother in 2015. Two years after transplant, classical Hodgkin lymphoma-like PTLD was diagnosed. The patient was resistant to six cycles of ABVD chemotherapy and four cycles of brentuximab vedotin.

Management and outcome

After the failure of ABVD and brentuximab vedotin, we started nivolumab therapy at a dose of 3 mg/kg every 2 weeks. After six cycles, we achieved a PET negative complete remission. After 10 cycles of nivolumab, the patient is still followed with a complete remission. Still, there is no evidence of acute or chronic GvHD, and therefore no need for immunosuppressive treatment. No auto-immune complication was observed. It is planned to give nivolumab treatment to the patient until the progression.

Discussion

Our case has depicted that the classical Hodgkin lymphoma type PTLD may be resistant to the conventional treatments and anti-CD30 brentuximab vedotine. In such cases, nivolumab may be an effective and worth assessing agent in terms of both activity and safety profile.

Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall

We report a case of classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder (HL-PTLD) after kidney transplantation to highlight the difficulty of distinguishing this disorder from Hodgkin lymphoma-like PTLD (HL-like PTLD). Through this case report and literature review, we seek to clarify definitive pathologic features to differentiate these two conditions. A 38-year-old male kidney transplant recipient who had been receiving immunosuppressants was admitted to our hospital with unidentified high fever. Computed tomography images and blood tests indicated a lymphoproliferative disorder. Abdominal lymph node biopsy was performed, and microscopic examination revealed the presence of many large atypical cells in a background of dense T cell accumulation. The large, atypical cells were positive for Epstein-Barr Virus (EBV)-encoded small RNAs (EBER) in situ hybridization, EBV-LMP1, CD30 and PAX5, but negative for CD15, CD20 and CD45. Except for CD15-negativity, this immunohistochemical pattern was consistent with that of classical Hodgkin lymphoma. By close examination of the above immunoreactivities and the patient's subsequent chemosensitive clinical course, we finally made a diagnosis of HL-PTLD.

A 47-year-old stem cell transplant recipient with fever, cough and chest pain

Infections and malignancies are among the most serious complications that follow organ or stem cell transplantation. They may have a mild course, and nonspecific and overlapping manifestations. The present article describes a case of symptomatic nodular pulmonary disease that complicated hematopoietic stem cell transplantation. It was diagnosed to be post-transplant lymphoproliferative disorder, a potential sequela of immunosuppression and a very difficult entity to treat in profoundly immunosuppressed patients.