Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients

Autor: Jose Nery, Juan Madariaga, Barry Gelman, Spiros Delis, Naveen K Mittal, Andreas G. Tzakis, Robert Cirocco, Philip Ruiz, Tomoaki Kato, Thierry Berney, David Levi, Seigo Nishida
Rok vydání: 2002
Předmět:
Graft Rejection
Male
Epstein-Barr Virus Infections
Lymphoma
medicine.medical_treatment
medicine.disease_cause
Antibodies
Monoclonal
Murine-Derived
immune system diseases
hemic and lymphatic diseases
Child
Graft Rejection/drug therapy
ddc:617
Incidence (epidemiology)
Muromonab-CD3/therapeutic use
Antibodies
Monoclonal
Middle Aged
Intestines/transplantation
Intestines
surgical procedures
operative
Treatment Outcome
Child
Preschool
Rituximab
Lymphoma/virology
Female
Immunosuppressive Agents
medicine.drug
Adult
medicine.drug_class
Antineoplastic Agents/adverse effects/therapeutic use
Antineoplastic Agents
Monoclonal antibody
Herpesviridae
medicine
Humans
Epstein-Barr Virus Infections/complications
Retrospective Studies
Transplantation
Lymphoproliferative Disorders/drug therapy/etiology/virology
Organ Transplantation/adverse effects
business.industry
Antibodies
Monoclonal/adverse effects/therapeutic use
Infant
Immunotherapy
Organ Transplantation
medicine.disease
Epstein–Barr virus
Lymphoproliferative Disorders
Immunology
Immunosuppressive Agents/administration & dosage/therapeutic use
business
Muromonab-CD3
Zdroj: Transplantation, Vol. 74, No 7 (2002) pp. 1000-6
ISSN: 0041-1337
Popis: Posttransplant Epstein-Barr virus-associated B-cell lymphoproliferative disease (PTLD) has a higher incidence after intestinal transplantation than after transplantation of other solid organs and is associated with a high mortality. A new anti-CD20 monoclonal antibody, rituximab, has shown efficiency in the treatment of B-cell lymphoma, including PTLD, but its use has not yet been reported in intestinal transplant recipients.We retrospectively reviewed five patients who were diagnosed with PTLD from March 1999 to August 2001, after intestinal transplantation. These patients were primarily managed with rituximab, associated with reduction or interruption of immunosuppression and antiviral therapy with ganciclovir and cytomegalovirus immune globulin. Rituximab was administered at weekly doses of 375 mg/m until full remission was ascertained, and the interval between doses was then increased. No patient received chemotherapy.One patient had nonmalignant lymphoproliferation, and four had malignant PTLD, as assessed by histopathology and monoclonality of the tumor. Two pediatric patients had severe generalized disease. All patients had received OKT3 as treatment of rejection before developing PTLD. All tumors showed proliferation of CD20 cells and were positive for Epstein-Barr virus by in situ hybridization. All patients responded to rituximab therapy and have achieved full remission with a follow-up of 3 to 30 (median, 8) months.Prolonged rituximab treatment, in association with reduction of immunosuppression and antiviral therapy, is highly efficient as part of the first-line treatment of CD20 B-cell PTLD after intestinal transplantation.
Databáze: OpenAIRE
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