Long-term complete remission and immune tolerance after intensive chemotherapy for lymphoproliferative disorders complicating liver transplant.
BACKGROUND
B cell lymphoproliferative disorders (LPD) and liver rejection are major lethal complications after hepatic transplantation. Reduction in immunosuppression is the treatment for the former, but is a risk factor for the latter.


METHODS
Here, we report three consecutive children with monoclonal LPD complicating orthotopic liver transplantation. All of them were treated with brief (<4 months) but intensive chemotherapy.


RESULTS
These three patients have remained in complete remission for LPD for 18 months to more than 3 years. Aggressive antimicrobial prophylaxis was successful in preventing life-threatening infections. The patient who received the highest cumulative doses of chemotherapy may have also developed relative immune tolerance to the allograft.


CONCLUSIONS
High-dose-intensity chemotherapy may be effective in the treatment of monoclonal LPD, as well as in the induction of immune tolerance for the prevention of allograft rejection and LPD recurrence.
Leung
W
W
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. wileung@jhmi.edu
Colombani
P
P
Lau
H
H
Schwarz
K
K
Wise
B
B
Friedman
A D
AD
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D012074:Remission Induction; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D000212:Acyclovir