title: Successful outcome with a "quintuple approach" of posttransplant lymphoproliferative disorder.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: Schaar
authors.forename: J W
authors.initials: JW
authors.lastname: van der Pijl
authors.forename: B
authors.initials: B
authors.lastname: van Hoek
authors.forename: J W
authors.initials: JW
authors.lastname: de Fijter
authors.forename: R A
authors.initials: RA
authors.lastname: Veenendaal
authors.forename: P M
authors.initials: PM
authors.lastname: Kluin
authors.forename: J H
authors.initials: JH
authors.lastname: van Krieken
authors.forename: A
authors.initials: A
authors.lastname: Hekman
authors.forename: W E
authors.initials: WE
authors.lastname: Terpstra
authors.forename: R
authors.initials: R
authors.lastname: Willemze
authors.forename: H C
authors.initials: HC
authors.lastname: Kluin-Nelemans
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D016898:Interferon-alpha; D000212:Acyclovir