Successful outcome with a "quintuple approach" of posttransplant lymphoproliferative disorder.
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-alpha; 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-alpha 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).


CONCLUSIONS
This combined approach resulted in a favorable outcome in patients with high risk monoclonal PTLD after solid organ transplantation.
Schaar
C G
CG
Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands.
van der Pijl
J W
JW
van Hoek
B
B
de Fijter
J W
JW
Veenendaal
R A
RA
Kluin
P M
PM
van Krieken
J H
JH
Hekman
A
A
Terpstra
W E
WE
Willemze
R
R
Kluin-Nelemans
H C
HC
D000212:Acyclovir / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012074:Remission Induction; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D016898:Interferon-alpha; D000212:Acyclovir