Living-donor liver transplantation providing an adequate chemotherapy for a pediatric patient with anaplastic large cell
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CASE REPORT
Living‑donor liver transplantation providing an adequate chemotherapy for a pediatric patient with anaplastic large cell lymphoma complicated with liver failure due to the aggravation of biliary hepatopathy by secondary hemophagocytic lymphohistiocytosis Kenichi Sakamoto1 · Tomoo Osumi1 · Satoshi Yoshimura1 · Seiichi Shimizu3 · Motohiro Kato1 · Daisuke Tomizawa1 · Akinari Fukuda3 · Seisuke Sakamoto3 · Noriyuki Nakano4 · Takako Yoshioka4 · Osamu Miyazaki5 · Syunsuke Nosaka5 · Takao Deguchi1 · Nobutaka Kiyokawa2 · Mureo Kasahara3 · Kimikazu Matsumoto1 Received: 8 April 2020 / Revised: 24 June 2020 / Accepted: 14 July 2020 © Japanese Society of Hematology 2020
Abstract Anaplastic large cell lymphoma (ALCL) accounts for 10–15% of childhood non-Hodgkin lymphoma cases; it is generally chemo-sensitive and is one of the most curable pediatric cancers. We report here a case of pediatric ALCL complicated with acute liver failure due to the aggravation of pre-existing biliary hepatopathy by lymphoma-associated hemophagocytic lymphohistiocytosis (HLH). Although the initial treatment response against ALCL was very good, poor and irreversible liver function due to biliary cirrhosis worsening by lymphoma-associated HLH prevented the patient from receiving further consolidation chemotherapies. To make matters worse, his condition was accompanied with intrahepatic fungal pseudoaneurysm and invasive fungal infection. Thus, we decided to perform an urgent living-donor liver transplantation from his father to correct the patient’s liver function and make it possible to proceed with further ALCL therapy. After the living-donor liver transplantation, the patient successfully received consolidation therapy with brentuximab vedotin. To our knowledge, this may be an early reported case of a pediatric patient undergoing liver transplantation during treatment for ALCL. In most patients with HLH-associated ALCL, liver function improves when ALCL is controlled. However, acute liver failure is occasionally observed in HLH cases with pre-existing liver dysfunction. In such cases, liver transplantation should be considered to correct liver dysfunctions if the disease control of HLH is satisfactory. Keywords Anaplastic large cell lymphoma · Pediatric · Hepatic failure · Living-donor liver transplantation
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12185-020-02949-z) contains supplementary material, which is available to authorized users. * Kenichi Sakamoto sakamoto‑[email protected] 1
Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan
2
Anaplastic large cell lymphoma (ALCL) accounts for 10–15% of childhood non-Hodgkin lymphoma (NHL) cases. It is characterized by the t(2;5)(p23;q35) chromosome translocation leading to an expression of abnormal
3
Organ Transplantation Center, National Center for C
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