title: Long-term complete remission and immune tolerance after intensive chemotherapy for lymphoproliferative disorders complicating liver transplant.
abstract: 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.
authors.affiliation: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. wileung@jhmi.edu
authors.forename: W
authors.initials: W
authors.lastname: Leung
authors.forename: P
authors.initials: P
authors.lastname: Colombani
authors.forename: H
authors.initials: H
authors.lastname: Lau
authors.forename: K
authors.initials: K
authors.lastname: Schwarz
authors.forename: B
authors.initials: B
authors.lastname: Wise
authors.forename: A D
authors.initials: AD
authors.lastname: Friedman
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D000212:Acyclovir