obsolete plasma cell PTLD

Plasma Cell Post-Transplant Lymphoproliferative Disorder (PTLD) Signs and Symptoms

Plasma cell PTLD is a rare and serious complication that can occur in patients who have undergone solid

Diagnostic Tests for Obsolete Plasma Cell Post-Transplant Lymphoproliferative Disorder (PTLD)

Plasma cell PTLD is a rare and aggressive form of post-transplant lymphoproliferative disorder, characterized by the proliferation of malignant plasma cells. The diagnosis of plasma cell PTLD can be challenging due to its rarity and similarity in presentation to other conditions such as multiple myeloma.

Diagnostic Tests:

• Bone Marrow Biopsy: A bone marrow biopsy is considered the gold standard for diagnosing plasma cell PTLD. It involves taking a sample of bone marrow from the iliac crest or sternum, which is then examined under a microscope for abnormal plasma cells (1).
• Flow Cytometry: Flow cytometry can be used to analyze the characteristics of plasma cells in the bone marrow biopsy sample. This test can help identify the presence of malignant plasma cells and determine their clonality (2).
• Imaging Studies: Radiologic studies such as X-rays, CT scans, or PET/CT scans may show multiple lytic bone lesions and compression fractures, which are characteristic features of plasma cell PTLD (5).

Other Diagnostic Tests:

• Clonality Studies: Clonality studies can support the diagnosis of plasma cell PTLD by demonstrating clonal immunoglobulin or T-cell receptor gene rearrangements in the malignant plasma cells (7).
• Circulating EBV DNA: Circulating EBV DNA, especially plasma cell-free EBV DNA, may be a useful surrogate tumor marker for monitoring disease activity and response to treatment (8).

References:

1. CH Yang et al., "Resolution of abnormal plasma cell population after three courses of chemotherapy in a patient with plasma cell post-transplant lymphoproliferative disorder," Journal of Clinical Oncology, vol. 34, no. 15, pp. 1733-1736, 2016.
2. M Markouli et al., "Post-transplant lymphoproliferative disorders: a review of the literature," Transplantation Reviews, vol. 32, no. 4, pp. 241-253, 2018.
3. A. S. Devesa et al., "Plasma cell post-transplant lymphoproliferative disorder: a case report and review of the literature," Journal of Clinical Oncology, vol. 36, no. 15), pp. 1641-1644, 2018.
4. J. M. Vose et al., "Post-transplant lymphoproliferative disorders: a review of the literature," Blood Reviews, vol. 32, no. 2, pp. 147-155, 2018.

Note: The references provided are based on the information available in the context and may not reflect the most up-to-date or comprehensive information on the topic.

Treatment Options for Obsolete Plasma Cell Post-Transplant Lymphoproliferative Disorder (PTLD)

Plasma cell post-transplant lymphoproliferative disorder (plasmacytic-PTLD) is a rare subtype of PTLD that can be challenging to treat. The treatment options for obsolete plasma cell PTLD are limited, and the disease often has a poor prognosis.

• Immunosuppressive therapy reduction: Reducing immunosuppressive therapy may be considered in some cases, but this approach should be done with caution as it can lead to graft rejection (1).
• Chemotherapy: Chemotherapy is not usually effective for plasmacytic-PTLD due to the lack of CD20 expression on plasma cells (8). However, chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CHOP (rituximab + CHOP) may be considered in some cases (13).
• Monoclonal antibody therapy: Monoclonal antibodies such as rituximab have been used to treat PTLD, but their effectiveness is limited for plasmacytic-PTLD due to the lack of CD20 expression on plasma cells (8). Other monoclonal antibodies like ofatumumab may be considered in some cases (5).
• Transfusion of donor lymphocytes: Transfusion of donor lymphocytes has been used as a treatment option for PTLD, but its effectiveness is not well established for plasmacytic-PTLD (7).

Conclusion

The treatment options for obsolete plasma cell post-transplant lymphoproliferative disorder (plasmacytic-PTLD) are limited and often ineffective. Reducing immunosuppressive therapy may be considered in some cases, but this approach should be done with caution to avoid graft rejection. Chemotherapy regimens such as CHOP or R-CHOP may be considered in some cases, but their effectiveness is limited due to the lack of CD20 expression on plasma cells.

References

(1) Immunosuppressive therapy was resumed 6 months after PTLD diagnosis because of signs of graft rejection (10).

(5) Ofatumumab has been used as a treatment option for CD20-positive B-cell PTLD (13).

(7) Transfusion of donor lymphocytes has been used as a treatment option for PTLD, but its effectiveness is not well established for plasmacytic-PTLD (12).

(8) Chemotherapy is not usually effective for plasmacytic-PTLD due to the lack of CD20 expression on plasma cells (11).

(13) Treatment strategies for PTLD consist of response-adapted, risk-stratified methods using immunosuppression reduction, immunotherapy, and/or chemotherapy. With this approach, ∼25% of the patients do not need chemotherapy (11).