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Positron emission tomography in the diagnosis and therapeutic monitoring of post-transplant lymphoproliferative disorder after cord blood transplantation

Bone Marrow Transplantation volume 45, pages 610–612 (2010)Cite this article

Post-transplant lymphoproliferative disorder (PTLD) is a rare but potentially life-threatening complication of solid organ transplantation (SOT) and allo-SCT. It encompasses a heterogeneous group of lymphoproliferative disorders ranging from benign lymphoid hyperplasia to high-grade malignant lymphoma.1 Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) has been reported to be useful in patients with PTLD after SOT.2, 3, 4, 5, 6 However, to our knowledge, there has been no report on the use of FDG-PET in PTLD after allo-SCT. In this study, we describe a case of polymorphic PTLD arising after cord blood transplantation, in which FDG-PET was effective for staging and therapeutic monitoring.

In recent years, FDG-PET has been developed as a new diagnostic technique for the management of lymphoma. Clinical experience indicates that FDG-PET scan is more sensitive and specific than contrast-enhanced CT imaging for intermediate- to high-grade non-Hodgkin’s lymphoma and Hodgkin’s disease. The major advantage of PET over conventional imaging resides in its ability to detect disease in the absence of morphological abnormalities. Moreover, FDG-PET scanning is helpful for evaluating treatment response, especially in patients with persistent lesions on CT scans. However, the value of PET scanning for low-grade lymphomas is not well established.7 Although PTLD is related to lymphoma, the heterogeneity of PTLD prevents direct extrapolation of these results to cases of PTLD, especially those of the polymorphic type. Although PTLD arising after SOT and allo-SCT share many common features, such as extranodal involvement, EBV positivity and B-cell phenotype, there are some notable differences between them. PTLD arising after allo-SCT develops earlier and is more likely to present with fulminant and disseminated disease.8 EBV is found in nearly 100% of cases of PTLD after allo-SCT; whereas, up to 15% of cases of PTLD after SOT are EBV-negative. The majority of PTLD cases arising after SOT are of recipient origin; whereas, those arising after allo-SCT are of donor origin.8 Although withdrawal of immunosuppressive therapy is the first-line therapy for PTLD after SOT, this treatment is ineffective in most cases after allo-SCT because of the severe immunosuppression caused by the conditioning regimen and graft manipulation.1

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    K Kataoka, S Seo, T Takahashi & M Kurokawa

  2. Department of Human Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    S Ota

  3. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan

    M Kurokawa

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  1. K Kataoka
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  2. S Seo
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Correspondence to M Kurokawa.

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Kataoka, K., Seo, S., Ota, S. et al. Positron emission tomography in the diagnosis and therapeutic monitoring of post-transplant lymphoproliferative disorder after cord blood transplantation. Bone Marrow Transplant 45, 610–612 (2010). https://doi.org/10.1038/bmt.2009.205

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