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.
- malignant disease and immunosuppression
- haematology (incl blood transfusion)
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Contributors ZT and FB contributed equally to this work. ZT and FB were responsible for planning, conduct, reporting, conception and design of the study. ZT and JP contributed to data collection. FB also obtained patient consent. ZT, FB and JP also took care of the patient. KL was involved in the extensive literature review and analysis of the collected clinical data. KL also played a key role in the interpretation of data. All authors (ZT, FB, JP and KL) were involved in drafting the article and provided insightful edits and reviews. All authors (ZT, FB, JP and KL) approved the final version of the manuscript and agreed to be accountable for its content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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