Post transplant lymphoproliferative disorder after autologous hematopoietic cell transplantation for hodgkin's lymphoma

ABSTRACT

Post-transplant lymphoproliferative disorder [PTLD] is a very rare complication post autologous bone marrow transplant with few cases reported so far. We report a case of a child with history of classic Hodgkin's lymphoma, nodular sclerosis type, who was treated with autologous stem cell transplantation Three mounths after the transplant, he developed bilateral cervical lymphadenopathy splenomegaly, neutropenia and thrombocytopenia Excisional biopsy of a left cervical lymph node revealed PTLD. The morphological pattern of the PTLD was combined monomorphic and polymorphic with plasmacytoid/plasmablastic differentiation expressing CD20 and CD79a. Kappa and lambda light chain stains show clear evidence of lambda light chain restriction. Immunohistochemistry stain and in situ hybridization for EBV [LMP-1] were positive for EBV. PCR study reveals a monoclonal B-cell proliferation with immunoglobulin heavy chain gene rearrangement. The patient was treated with predinsolone as 2 mg/kg/day over 2 weeks with tapering over the following 3 months. The white cell count recovered with regression of splenomegaly and cervical lymphadenopathy on his last visit to outpatient clinic he was in good health with normal laboratory parameters 2 years after the diagnosis of PTLD