Correlative morphologic and molecular genetic analysis demonstrates three distinct categories of posttransplantation lymphoproliferative disorders

Blood. 1995 Jan 15;85(2):552-65.

Abstract

The posttransplantation lymphoproliferative disorders (PT-LPDs) are a morphologically heterogeneous group of Epstein-Barr virus (EBV)-driven lymphoid proliferations of varying clonal composition. Some PT-LPDs regress after a reduction in immunosuppression, while others progress in spite of aggressive therapy. Previously defined morphologic categories do not correlate with clonality, and neither morphology nor clonality has reliably predicted the clinical behavior of PT-LPDs. We investigated 28 PT-LPD lesions occurring in 22 patients for activating alterations involving the bcl-1, bcl-2, c-myc, and H-, K- and N-ras proto-oncogenes and for mutations involving the p53 tumor suppressor gene. We correlated the results of these studies with the morphology of the lesions, their clonality based on Ig heavy and light chain gene rearrangement analysis, and the presence and clonality of EBV infection. We found that the PT-LPDs are divisible into three distinct categories as follows: (1) plasmacytic hyperplasia: most commonly arise in the oropharynx or lymph nodes, are nearly always polyclonal, usually contain multiple EBV infection events or only a minor cell population infected by a single form of EBV, and lack oncogene and tumor suppressor gene alterations; (2) polymorphic B-cell hyperplasia and polymorphic B-cell lymphoma: may arise in lymph nodes or various extranodal sites, are nearly always monoclonal, usually contain a single form of EBV, and lack oncogene and tumor suppressor gene alterations; and (3) immunoblastic lymphoma or multiple myeloma: present with widely disseminated disease, are monoclonal, contain a single form of EBV, and contain alterations of one or more oncogene or tumor suppressor genes (N-ras gene codon 61 point mutation, p53 gene mutation, or c-myc gene rearrangement). The PT-LPDs are divisible into three categories exhibiting distinct morphologic and molecular genetic characteristics. Alterations involving the N-ras and c-myc proto-oncogenes and the p53 tumor suppressor gene may play an important role in the development and/or progression of the PT-LPDs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Base Sequence
  • DNA, Neoplasm / genetics
  • DNA, Viral / genetics
  • Gene Rearrangement, B-Lymphocyte
  • Genes, Tumor Suppressor
  • Heart Transplantation / adverse effects
  • Heart Transplantation / immunology
  • Herpesviridae Infections*
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / isolation & purification
  • Herpesvirus 4, Human / pathogenicity*
  • Humans
  • Hyperplasia
  • Immunosuppressive Agents / adverse effects
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / immunology
  • Lung Transplantation / adverse effects
  • Lung Transplantation / immunology
  • Lymphoid Tissue / pathology
  • Lymphoid Tissue / virology
  • Lymphoma, B-Cell / genetics
  • Lymphoma, B-Cell / pathology
  • Lymphoma, B-Cell / virology
  • Lymphoproliferative Disorders / classification*
  • Lymphoproliferative Disorders / genetics
  • Lymphoproliferative Disorders / pathology
  • Lymphoproliferative Disorders / virology
  • Molecular Sequence Data
  • Multiple Myeloma / genetics
  • Multiple Myeloma / pathology
  • Multiple Myeloma / virology
  • Oncogenes
  • Point Mutation
  • Polymorphism, Single-Stranded Conformational
  • Postoperative Complications / classification*
  • Postoperative Complications / pathology
  • Postoperative Complications / virology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / virology
  • Tumor Virus Infections*

Substances

  • DNA, Neoplasm
  • DNA, Viral
  • Immunosuppressive Agents