title: Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients.
abstract: BACKGROUND
  Posttransplant Epstein-Barr virus-associated B-cell lymphoproliferative disease (PTLD) has a higher incidence after intestinal transplantation than after transplantation of other solid organs and is associated with a high mortality. A new anti-CD20 monoclonal antibody, rituximab, has shown efficiency in the treatment of B-cell lymphoma, including PTLD, but its use has not yet been reported in intestinal transplant recipients.
  
  
  METHODS
  We retrospectively reviewed five patients who were diagnosed with PTLD from March 1999 to August 2001, after intestinal transplantation. These patients were primarily managed with rituximab, associated with reduction or interruption of immunosuppression and antiviral therapy with ganciclovir and cytomegalovirus immune globulin. Rituximab was administered at weekly doses of 375 mg/m until full remission was ascertained, and the interval between doses was then increased. No patient received chemotherapy.
  
  
  RESULTS
  One patient had nonmalignant lymphoproliferation, and four had malignant PTLD, as assessed by histopathology and monoclonality of the tumor. Two pediatric patients had severe generalized disease. All patients had received OKT3 as treatment of rejection before developing PTLD. All tumors showed proliferation of CD20 cells and were positive for Epstein-Barr virus by in situ hybridization. All patients responded to rituximab therapy and have achieved full remission with a follow-up of 3 to 30 (median, 8) months.
  
  
  CONCLUSIONS
  Prolonged rituximab treatment, in association with reduction of immunosuppression and antiviral therapy, is highly efficient as part of the first-line treatment of CD20 B-cell PTLD after intestinal transplantation.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Spiros
authors.initials: S
authors.lastname: Delis
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Naveen K
authors.initials: NK
authors.lastname: Mittal
authors.forename: Juan
authors.initials: J
authors.lastname: Madariaga
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Jose R
authors.initials: JR
authors.lastname: Nery
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cirocco
authors.forename: Barry
authors.initials: B
authors.lastname: Gelman
authors.forename: Philip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008223:Lymphoma / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D016377:Organ Transplantation / Q000009:adverse effects; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D000069283:Rituximab