Page 126 - Haematologica3

Correspondence:
m.j.kersten@amc.uva.nl
Received: May 3, 2017.
Accepted: December 13, 2017. Pre-published: December 21, 2017.
doi:10.3324/haematol.2017.169987
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Non-Hodgkin Lymphoma
Clinicopathological characteristics of T-cell non-Hodgkin lymphoma arising in patients with immunodeficiencies: a single-center case series of 25 patients and a review
of the literature
Marieke L. Nijland,1# Lianne Koens,2# Steven T. Pals,3 Ineke J.M. ten Berge,1 Frederike J. Bemelman1 and Marie José Kersten4*
1Renal Transplant Unit, Department of Nephrology, Academic Medical Center; 2Department of Pathology, Academic Medical Center; 3Department of Pathology and Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Academic Medical Center and 4Department of Hematology and Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Academic Medical Center, Amsterdam, the Netherlands
ABSTRACT
Although it is known that B-cell lymphomas occur more frequently in immunocompromised patients, thus far such an association has not been clearly established for T-cell lymphomas. Of the 251 patients who were diagnosed with a T-cell non-Hodgkin lymphoma in our center between 1999 and 2014, at least 25 were identified in immunocompromised patients. Herein, we retrospectively analyzed the clinical and pathological characteristics of these 25 cases. In addition, we searched the literature and present an overview of 605 previously pub- lished cases. The actual number of patients with B-cell chronic lympho- cytic leukemia and patients on immunosuppressive drugs for inflamma- tory bowel disease or rheumatoid arthritis in the total cohort of 251 patients diagnosed with T-cell non-Hodgkin lymphoma was much high- er than the number of patients expected to have these diseases in this cohort, based on their prevalence in the general population. This, togeth- er with the large number of additional cases found in the literature, sug- gest that the risk of developing T-cell non-Hodgkin lymphoma is increased in immunocompromised patients. Compared to T-cell non- Hodgkin lymphoma in the general population, these lymphomas are more often located extranodally, present at a younger age and appear to have a poor outcome. The observations made in the study herein should raise awareness of the possible development of T-cell non-Hodgkin lym- phoma in immunodeficient patients, and challenge the prolonged use of immunosuppressive drugs in patients who are in clinical remission of their autoimmune disease.
Introduction
It has long been recognized that patients with either a primary or acquired immunodeficiency are at increased risk for the development of malignant lym- phomas.1,2 Hematopoietic stem cell and solid organ transplant recipients, for exam- ple, can develop post-transplant lymphoproliferative disease (PTLD);3 patients infected with the human immunodeficiency virus (HIV), patients with primary immunodeficiencies and patients treated for inflammatory bowel disease (IBD) with immunosuppressive drugs all have an increased risk for developing lym- phoma.4-8 Moreover, this complication is seen in patients with autoimmune dis- eases like rheumatoid arthritis (RA), primary Sjögren syndrome and systemic lupus erythematosus. However, it is not clear whether the lymphomas in these patients are triggered by chronic inflammation caused by the disease itself or by the (immunosuppressive) therapies used.9-13 In all the groups studied, the reported lym- phomas are predominantly of B-cell origin.3,5,11
Haematologica 2018 Volume 103(3):486-496
#MLN and LK contributed equally to this work.
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