The clinical and pathological features of plasma cell myeloma post solid organ transplantation

Autor: Suzanne Lentzsch, David C. Park, Rebecca J. Leeman-Neill, Govind Bhagat, Bachir Alobeid, George Vlad, Kenneth Ofori, Craig R. Soderquist, Vundavalli V. Murty
Rok vydání: 2020
Předmět:
Zdroj: American Journal of Hematology. 95:1531-1541
ISSN: 1096-8652
0361-8609
DOI: 10.1002/ajh.25988
Popis: Plasma cell neoplasms (PCNs), comprising plasma cell myelomas (PCMs) and plasmacytomas, occurring after solid organ transplantation, represent rare subtypes of monomorphic post-transplant lymphoproliferative disorders (M-PTLDs). Data regarding the clinical and pathological features of post-transplant (PT)-PCMs are limited. To gain a better understanding of disease biology, we performed comprehensive immunophenotypic analysis, reviewed cytogenetic analysis results and evaluated clinical outcomes of PT-PCMs diagnosed and treated at our institution. Fifteen PT-PCM (M: F - 4:1) and 2 PT-MGUS (2 males) cases were identified. The median age of PT-PCM patients was 68yrs (29-79 yrs) and PCMs presented at a median of 9.7yrs (0.5-24.7 yrs) after transplantation. PT-PCMs accounted for 11.6% of all M-PTLDs and the period prevalence was 9/3108 (0.29%), 3/1071 (0.28%), 2/1345 (0.15%) and 1/878 (0.11%) post kidney, heart, liver and lung transplantation. Lytic bone disease was observed in 1/11 (9%) patients. Marrow plasma cell infiltration ranged from 10%-70% (median 20%), with 10/15 (67%) and 5/15 (33%) cases manifesting immature and plasmablastic morphology. The immunophenotype of all cases and cytogenetic abnormalities, identified in 60% of cases, were similar to multiple myeloma (MM) of immunocompetent individuals. All PT-PCMs were EBER-. Ten of 11 (91%) patients with active MM were treated, all with proteasome inhibitor-based therapy. Treatment response and 5-year overall survival (54.5%) was comparable to MM of immunocompetent individuals. However, the survival of patients with plasmablastic PCMs was inferior to those with immature PCMs. 0ur findings indicate PT-PCMs to be predominantly late onset PTLDs that have similar clinicopathologic characteristics as conventional MM. This article is protected by copyright. All rights reserved.
Databáze: OpenAIRE
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