Double-hit monomorphic B-cell lymphoma after liver transplantation. Issue 1 (2nd January 2020)

• Record Type: Journal Article
• Authors: Tahir, Zabreen; Peters, Julia; Leahy, Kathleen; Batalini, Felipe
• Is Part Of: BMJ case reports. Volume 13:Issue 1(2020)
• Publication Date: 2020-01-02
• Subjects: malignant disease and immunosuppression -- haematology (incl blood transfusion) -- transplantation -- chemotherapy -- oncology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-231831
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd–Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen.