title: Anti-CD20 monoclonal antibody treatment of Epstein-Barr virus-induced intrahepatic lymphoproliferative disorder following liver transplantation.
abstract: Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorders (PTLDs) are a common cause of death in transplant patients. Their incidence following liver transplantation is reported to be between 0.5% and 4%. Despite various therapeutic approaches, there is still no consensus on a treatment strategy. The treatment of transplant recipients with monoclonal antibodies directed against B-cell antigens is a new, therapeutic approach with which, however, little clinical experience has so far been gained. Two patients developed intrahepatic PTLD 7 and 15 months, respectively, after transplantation. In one case, this was diagnosed as polymorphic PTLD, in the other as monomorphic, monoclonal PTLD. After having their immunosuppression terminated, 4 weeks after establishment of the diagnosis, both patients were treated with anti-CD20 antibodies (rituximab) at a dose of 375 mg/m(2) on days 1, 8, 15 and 22. Treatment with rituximab was tolerated well by both patients. One of the patients in whom cholestasis parameters remained high underwent re-transplantation. In one of the cases, the histological work-up confirmed necrosis of 90% of the tumour cells, and complete remission in the other. Both patients died of secondary complications 10 weeks and 10 months, respectively, after the diagnosis of PTLD. We can conclude that treatment of PTLD with Rituximab led to remission in both of our patients. Nevertheless, progression of cholestasis persisted, and both patients ultimately died of complications unrelated to PTLD.
authors.affiliation: Department of General Surgery, University of Erlagen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. syedibela@hotmail.com
authors.forename: Süleyman
authors.initials: S
authors.lastname: Yedibela
authors.forename: Thomas
authors.initials: T
authors.lastname: Reck
authors.forename: Gerald
authors.initials: G
authors.lastname: Niedobitek
authors.forename: Martin
authors.initials: M
authors.lastname: Gramatzki
authors.forename: Roland
authors.initials: R
authors.lastname: Repp
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Rudolf
authors.initials: R
authors.lastname: Ott
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D015703:Antigens, CD / Q000276:immunology; D018951:Antigens, CD20 / Q000276:immunology*; D001402:B-Lymphocytes / Q000276:immunology*; D017931:DNA Primers; D004359:Drug Therapy, Combination; D020031:Epstein-Barr Virus Infections / Q000276:immunology* / Q000517:prevention & control; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000187:drug effects / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000000981:diagnostic imaging / Q000276:immunology* / Q000517:prevention & control; D016133:Polymerase Chain Reaction; D000069283:Rituximab; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015703:Antigens, CD; D018951:Antigens, CD20; D017931:DNA Primers; D007143:Immunoglobulin Heavy Chains; D007166:Immunosuppressive Agents; D000069283:Rituximab