Burkitt’s Lymphoma Post Renal Transplantation: PTLD.Int Survey

Introduction: Burkitt‘s lymphoma is a well known type of malignant lymphoma in the general population; but in transplant era, it has not been defined as a distinct category of post transplant lymphoproliferative disorders (PTLD), possibly due to the very rare nature of this disease type in this population. In this first study, however, we aimed to find individual cases of Burkitt’s lymphomas reported by different series in the literature, and to compare their disease characters, behavior and prognosis with other PTLD patients reported by the same studies. Methods: A comprehensive search of the current literature was performed through Pubmed and Google Scholar for reports or series including individual cases of Burkitt’s lymphomas developing post renal transplantation. Overall 23 cases of Burkitt’s PTLD were found whose data were compared to 103 renal transplant patients with other PTLD types. Immunosuppression types were comparable between the two groups (p=0.922). Results: Burkitt’s PTLD were significantly more likely to occur in the paediatric age (vs. adults; 41% vs. 13%, respectively; p=0.005); and as late onset disease (>1 year posttransplant; 100% vs. 81%; p=0.035). Multi-organ PTLD (53% vs. 15%, respectively; p=0.004), Bone marrow complication (26% vs. 2%, respectively; p=0.003) and liver metastasis (12.5% vs. 0; p=0.043) were more frequently seen in the Burkitt’s PTLD group. Time interval from transplantation to PTLD development and survival of the patients were comparable between the two groups. Conclusions: Burkitt’s lymphoma in renal transplant recipients is more likely to complicate children and to develop metastatic disease, especially within the bone marrow and the liver. So it is recommended to evaluate renal recipients whose PTLD lesions were histopathologically defined as Burkitt’s lymphoma, for potential metastatic lesions especially within the liver and/or bone marrow. Prospective studies are suggested for confirming these results.