Complete regression of recurrent diffuse malignant lymphoma after withdrawal of cyclosporin A in a renal transplant recipient

Malignancy develops in patients who have received organ transplants much more frequently than would be anticipated in an age-matched non-transplanted population, and is a major cause of mortality in this patient group [1]. Non-Hodgkin lymphomas are especially prevalent and may account for up to 28% of all post-transplant malignancies [2]. The nature and dosage of immunosuppressive therapy is thought to influence the epidemiology of these tumours [2-4], but their pathogenesis has also been strongly linked to viral infections, notably the Epstein-Barr virus (EBV) [5]. Maximum opportunity for tumour regression occurs only when the immunosuppressive regime is significantly reduced (particularly in the case of cyclosporin A dosage) [5,6], irrespective of treatment specifically directed at the lymphoma. This may of course lead to undesirable organ rejection and graft loss. We report the case of a woman who developed diffuse intra-abdominal lymphoma 7 years after renal transplantation. Despite surgical debulking and intensive chemotherapy the tumour relapsed; complete regression of the lymphoma was only achieved after withdrawal of cyclosporin A, the introduction of prednisolone and azathioprine allowing renal allograft function to be retained.