# Neuroimaging features of primary central nervous system post-transplantation lymphoproliferative disorder following hematopoietic stem cell transplant in patients with β-thalassemia: a case series and review of literature

## TL;DR

This paper reports on rare brain-related lymphoproliferative disorder in β-thalassemia patients after stem cell transplants, highlighting neuroimaging features and clinical outcomes.

## Contribution

The study presents a case series and literature review of PCNS-PTLD in β-thalassemia patients post-HSCT, focusing on neuroimaging and clinical characteristics.

## Key findings

- PCNS-PTLD in β-thalassemia patients typically presents with intracerebral lesions involving multiple brain regions.
- Neuroimaging features include homogeneous or rim enhancement of brain lesions.
- Median survival after diagnosis was 83 days with low treatment response.

## Abstract

Primary central nervous system post-transplantation lymphoproliferative disorder (PCNS-PTLD) is a rare but serious complication of hematopoietic stem cell transplantation (HSCT) in patients with severe β-thalassemia. This study aimed to assess the clinical presentation, pathological characteristics, neuroimaging findings, and treatment strategies in patients with β-thalassemia who developed PCNS-PTLD and to compare a case series from our transplant center to reported cases from literature.

We retrospectively reviewed our hospital database and identified four cases of pathologically confirmed PCNS-PTLD without a history of systemic PTLD in patients with severe β-thalassemia after HSCT. We also performed a relevant literature review on PCNS-PTLD.

The median time from transplantation to diagnosis of PCNS-PTLD was 5.5 months. Intracerebral lesions were usually multiple involving both supratentorial and infratentorial regions with homogeneous or rim enhancement. All patients had pathologically confirmed PCNS-PTLD with three patients having diffuse large B-cell lymphoma and the fourth patient having plasmacytic hyperplasia. There was low response to treatment with a median survival of 83 days.

PCNS-PTLD should be considered in the differential diagnosis of patients with β-thalassemia who had an intracranial lesion on neuroimaging after HSCT.

This case series with a comprehensive review of neuroimaging and clinical characteristics of children with primary central nervous system post-transplantation lymphoproliferative disorder should advance our understanding and improve management of this rare yet severe complication following transplant for β-thalassemia.

• We assessed clinical presentation, treatment strategies, and neuroimaging characteristics of PCNS-PTLD in patients with β-thalassemia after transplantation.

• Patients with β-thalassemia may have post-transplantation lymphoproliferative disorder presenting as brain lesions on neuroimaging.

• Neuroimaging findings of the brain lesions are helpful for prompt diagnosis and proper management.

The online version contains supplementary material available at 10.1186/s13244-024-01605-y.