SUCCESSFUL OUTCOME WITH A “QUINTUPLE APPROACH” OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER
作者:
Cees Schaar,
Johan van der Pijl,
Bart van Hoek,
Johan de Fijter,
Roeland Veenendaal,
Philip Kluin,
Johan van Krieken,
Annemarie Hekman,
Wim Terpstra,
Roel Willemze,
Hanneke Kluin-Nelemans,
期刊:
Transplantation
(OVID Available online 2001)
卷期:
Volume 71,
issue 1
页码: 47-52
ISSN:0041-1337
年代: 2001
出版商: OVID
数据来源: OVID
摘要:
Background.The treatment of posttransplant lymphoproliferative disorder (PTLD) remains empirical. We review our treatment of seven cases of PTLD consisting of five interventions: 1) reduction of immunosuppression; 2) antiviral drugs; 3) interferon-&agr;; 4) gamma-globulins; and 5) anti-CD19 monoclonal antibodies.Methods and Results.Seven consecutive patients who had undergone a simultaneous pancreas-kidney, liver, heart, or kidney transplantation were treated. One patient acquired a primary EBV infection with an oligoclonal immunoblastic lymphoma early after pancreas-kidney transplantation; all others developed a monoclonal polymorphic or immunoblastic lymphoma 2 to 123 months after transplantation. In all patients extranodal sites were involved, in three the graft was also involved. Five patients received the full quintuple approach and all rapidly obtained a complete remission (CR) with a median follow-up of 31 months (7-74 months). Of the two patients who did not receive interferon-&agr; for fear of graft rejection one responded slowly with a CR after 7 months, and the other obtained a rapid CR followed by a relapse at 4 months. All three patients with a liver or heart transplant could keep their graft. All patients are still alive with a median follow-up of 31 months (7-74 months).Conclusion.This combined approach resulted in a favorable outcome in patients with high risk monoclonal PTLD after solid organ transplantation.
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