SP747The EBV-associated Late Onset of Diffuse Large B-cell Lymphoma of Brain in Renal Transplant Recipients in Taiwan

Abstract

INTRODUCTION: The post-transplant lymphoproliferative disease (PTLD) is less common malignancy in renal transplant (RTx) recipients in Taiwan, but the primary brain lymphoma (PCNSL) is the major PTLD observed in our institute. Because it is rare in RTx recipients, the diagnosis of PCNSL is often challenging, and the optimal therapy is not established. METHODS: The study is to describe the clinical, histological, and radiological features of primary central nervous lymphoma (PCNSL) and their outcome and the association of Epstein-Barr virus (EBV) infection in our center. RESULTS: In the 1383 kidney transplant (KTx) recipients, there are seven patients with tissue-proven brain lymphoma. The mean duration after RTx of brain lymphoma was 12.2±5.6 yrs (range: 8.7-22.8 yrs). The most common symptoms were headache (100%), conscious disturbance (75%), vomiting (75%), hyponatremia (50%). Cerebral computed tomography (CT) scans and magnetic resonance imaging (MRI) revealed multifocal lesions (n=7) similar to brain abscesses, with a ring of contrast enhancement (n=7). The pathology disclosed diffuse large B-lymphocytes in the perivascular spaces. EBV was detected by in situ hybridization for EBV-EBER to disclose the EBV inclusion in the nuclei of lymphoma cells. All of them received 20-30 Gy of whole-brain radiotherapy after complete resection of PCNSL. All patients were still survival (mean 36.5 months, range 8.6 to 57.6 months), but three out of four patients started on hemodialysis due to chronic allograft rejection. CONCLUSIONS: Though, the EBV inclusion was found in PCNSL, the role of EBV in PCNSL still remains to be clarified. PTLD is a rare malignancy following KTx with a predilection of brain involvement in Taiwan. The minimized immunosuppressants and combination of whole-brain radiotherapy after complete resection of PCNSL seems to prolong patient survival.