ESPN 51th Annual Meeting

ESPN 2018


 
Burkitt lymphoma in a pediatric renal transplant recipient: an agressive type of post-transplant lymphoproliferation
EDA DIDEM KURT-SUKUR 1 ZEYNEP BIRSIN ÖZÇAKAR 1 NILGUN CAKAR 1 IŞINSU KUZU 2 NURDAN TAÇYILDIZ 3 EMEL ÜNAL 3 HANDAN DİNCASLAN 3 ECE MEKIK 1 FATOŞ YALÇINKAYA 1

1- ANKARA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- ANKARA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PATHOLOGY
3- ANKARA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF PEDIATRIC ONCOLOGY
 
Introduction:

Burkitt lymphoma (BL) is a rare but aggressive subtype of post-transplant lymphoproliferative disease (PTLD) and is reported to have a high incidence of EBV expression. Herein we report a pediatric renal transplant patient who developed BL after transplantation.

Material and methods:

A cadaveric renal transplantation (Tx) was performed in a 3-year-old boy with Prune Belly Syndrome.  The induction protocol was composed of basiliximab, tacrolimus, mycophenolate mofetil (MMF) and steroids. Seroprevalance for EBV was positive in the pre-transplant setting and the patient was regularly screened for serum EBV DNA titers after Tx.  In the 15th month of Tx his serum EBV PCR load was found to be high (16400 copies/ml). Immunosuppression was reduced and during the next 2 year-follow-up his EBV titers were within normal limits. In his 3rd year the patient started suffering from recurrent upper respiratory tract infections. Physical examination revealed enlarged tonsils and adenoid tissue and adenotonsillectomy was performed.  Pathological examination showed follicular hyperplasia with rare intraepithelial EBV-DNA positivity. In the 50th month post-Tx the patient came to medical attention with a 2x1.5cm, fixed, painless, suboccipital lymphadenopathy. Excisional biopsy confirmed the diagnosis of BL. Tacrolimus was switched to everolimus, MMF was stopped, steroid dose was increased to 10 mg/day. Rituximab and 4 doses of modified chemotherapy were given and remission was achieved. The patient has been free of the disease during follow-up for the last 12 months.

Results:

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Conclusions:

Early detection of PTLD in renal transplant patients is of great significance. Regular screening for EBV DNA titers and decreasing the immunosuppressive treatment when a significant increase in EBV is detected is the first step in management. Early diagnosis and prompt intervention with anti-CD20 treatment modalities are essential.