Treatment of Epstein-Barr virus-induced posttransplantation lymphoproliferative disorder with foscarnet alone in an adult after simultaneous heart and renal transplantation.
BACKGROUND
The kind and intensity of immunosuppression as well as Epstein-Barr virus, a transforming herpes virus that selectively infects B lymphocytes and causes infectious mononucleosis, have been implicated in the development of posttransplantation lymph-proliferative disorders (PT-LPD), a life-threatening complication of solid organ transplantation. The morphologic spectrum of PT-LPD ranges from polymorphous hyperplasia to monomorphous B-non-Hodgkin lymphomas. Among different modalities of treatment, reduction of immunosuppression with or without co-administration of antiviral agents may result in PT-LPD regression especially in mononucleosis-like disease.


METHODS
Nonmononucleosis-like PT-LPD in a simultaneous heart and renal recipient was treated with Foscarnet, a potent inhibitor of different herpes viruses with a low profile of toxicity, although intensive immunosuppression therapy was maintained.


CONCLUSIONS
A 4-week course of Foscarnet resulted in relapse-free complete remission (follow-up 10+ months). Thus, antiviral treatment with Foscarnet, may induce prolonged remission in nonmononucleosis-like PT-LPD without reduction of immunosuppression.
Oertel
S H
SH
Department of Haematology and Oncology, Charite-Campus Virchow, Medizinische Fakultät der Humboldt Unversität, Berlin, Germany.
Ruhnke
M S
MS
Anagnostopoulos
I
I
Kahl
A A
AA
Frewer
A F
AF
Bechstein
W O
WO
Hummel
M W
MW
Riess
H B
HB
D000998:Antiviral Agents / Q000627:therapeutic use*; D017245:Foscarnet / Q000627:therapeutic use*; D016027:Heart Transplantation; D004854:Herpesvirus 4, Human; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications / Q000188:drug therapy*; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D000998:Antiviral Agents; D017245:Foscarnet