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Hepatosplenic gamma-delta T-Cell Lymphoma as a Late-Onset Posttransplant Lymphoproliferative Disorder in Renal Transplant Recipients

Hong Wu MD, PhD, Mariusz A. Wasik MD, Grzegorz Przybylski MD, PhD, Janet Finan, Brenda Haynes MD, Halle Moore MD, Debra G.B. Leonard MD, PhD, Kathleen T. Montone MD, Ali Naji MD, Peter C. Nowell MD, PhD, Malek Kamoun MD, PhD, John E. Tomaszewski MD, Kevin E. Salhany MD
DOI: http://dx.doi.org/10.1309/YTTC-F55W-K9CP-EPX5 487-496 First published online: 1 April 2000

Abstract

We report 2 cases of renal transplant recipients in whom hepatosplenic gamma-delta T-cell lymphoma (gamma-delta HSTCL) developed 5 and 10 years after transplantation. Both patients had marked hepatosplenomegaly, B symptoms (weight loss, fever, and night sweats), and abnormal peripheral blood findings, including anemia in both, thrombocytopenia and leukoerythroblastic changes in 1, and leukocytosis in the other. Markedly atypical lymphoid infiltrate of intermediate to large cells was observed in the spleen, liver, and bone marrow. The malignant cells showed typical immunophenotype of gamma-delta T cells (CD2+, CD3+, CD4–, CD8–, CD7+, gamma-delta Tcell receptor–positive, and alpha-beta T-cell receptor–negative) with clonal T-cell receptor gene rearrangement and were of the V-delta-1 subset. In addition, the cells contained a cytolytic granule– associated protein, TIA-1, and Fas ligand, indicating cytotoxic T-cell differentiation. The malignant T cells in both cases were of host tissue origin. Both cases were negative for Epstein-Barr virus genome using Southern blot analysis. The patients did not respond to reduction of immunosuppression. Despite initial response to chemotherapy, both patients died within 6 months of diagnosis. Our findings indicate that gamma-delta HSTCL can occur as a late complication in transplant recipients.

Key Words:
  • Posttransplant lymphoproliferative disorder
  • Immunosuppression
  • T-cell lymphoma
  • Hepatosplenic gamma-delta T-cell lymphoma