Successful treatment with rituximab of lymphoproliferative disorder in a child after cardiac transplantation.
Post-transplantation lymphoproliferative disorders (PTLDs) are life-threatening complications. We report the case of a 7-year-old girl in whom a lymphoproliferative disorder developed more than 2 years after cardiac transplantation. The patient was taking ganciclovir for Epstein-Barr virus hepatitis at the time the PTLD occurred. Rituximab, an anti-CD20 monoclonal antibody, given in the presence of reduced immunosuppression therapy, resulted in a complete response of the PTLD. The Epstein-Barr viral load in the peripheral blood, which was extremely high at diagnosis, dropped promptly and remained below the detection threshold 11 months after completion of therapy. We observed complete depletion of B lymphocytes until 7 months after rituximab therapy, which was associated with an important decrease in immunoglobulin levels.
Herman
Jean
J
Department of Pediatric Transplantation, University Hospital Gasthuisberg, Kuleuven University, 49 Herestraat, 3000 Leuven, Belgium. jean.herman@uz.kuleuven.ac.be
Vandenberghe
Peter
P
van den Heuvel
Ingeborg
I
Van Cleemput
Johan
J
Winnepenninckx
Veronique
V
Van Damme-Lombaerts
Rita
R
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000601:surgery; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D008279:Magnetic Resonance Imaging; D018570:Risk Assessment; D000069283:Rituximab; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019562:Viral Load
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab