Classic Hodgkin lymphoma post-transplant lymphoproliferative disorders (PTLD) are often preceded by discordant PTLD subtypes

Abstract

Classic Hodgkin lymphoma (CHL) is the rarest post-transplant lymphoproliferative disorder (PTLD) subtype. Few cases of patients with metachronous discordant PTLD episodes including CHL-PTLD have been reported, but the incidence of and risk factors for this phenomenon are unknown. Patients with CHL-PTLD were identified from an institutional PTLD database. Of 13 patients identified with CHL-PTLD six (46%) had antecedent non-CHL-PTLD: three had polymorphic PTLD, two monomorphic PTLD, and one nondestructive PTLD. Patients with prior metachronous non-CHL-PTLD were younger at transplant and had a longer latency time to CHL-PTLD post-transplant. The prevalence of EBV seronegativity at transplant was high in both groups, but prolonged high-level EBV DNAemia only occurred in some with metachronous non-CHL-PTLD. In conclusion, patients with CHL-PTLD have metachronous non-CHL-PTLD diagnoses with discordant histology more commonly than previously recognized. Primary EBV infection with chronically elevated EBV viral loads may represent unique risk factors for CHL-PTLD following an initial non-CHL-PTLD event.

Keywords:

• Lymphoma
• immunocompromised hosts
• Hodgkin disease
• Epstein Barr virus
• transplantation

Acknowledgments

We would like to acknowledge Eugeniu Jantuan, Dr. Julinor Bacani, and Candice McEachren for cataloguing pathology material. We would also like to thank Dr. Patricia Campbell for her assistance obtaining HLA data.

Dr. Ryan J. Stubbins acknowledges training award support from the Clinician Investigator Program at the University of British Columbia, The Leukemia Lymphoma Society of Canada, and the Canadian Institutes of Health Research.

Disclosure statement

Anthea Peters: Advisory Boards (Roche, Abbvie, Janssen, Gilead, AstraZeneca), Honoraria (Abbvie, Janssen, Gilead).

The other authors report no conflict of interest.

Additional information

Funding

Funding for this study was provided by the Collaborative Research and Innovations (CRIO) grant program through Alberta Innovate Health Solutions (AIHS).