Successful prolonged rituximab treatment for post-transplant lymphoproliferative disorder following living donor liver transplantation in a child.
PTLD is a serious complication of immunosuppression in solid organ transplant recipients. The incidence of PTLD is significantly higher in pediatric recipients than in adult because children are often EBV-seronegative and they may develop primary EBV infection after transplantation. We herein describe a case of GI-PTLD who achieved a complete remission by prolonged rituximab, a chimeric monoclonal antibody against CD20, mono-therapy. A one-yr-old female underwent a LDLT for liver failure after having previously undergone the Kasai procedure for biliary atresia. At sixty days following the transplantation, GI-PTLD developed. Withdrawal of immunosuppression and a surgical resection were thus performed. A histopathological examination of tumor revealed atypical medium to large cell lymphoid proliferation with strong CD20 immunopositivity indicating their B-cell origin. Polymorphic PTLD was diagnosed. Rituximab was administered at a dose of 375 mg/m2 once a week, and the monotherapy resulted in a complete remission after 34 administrations. Based on this case, rituximab appears to be beneficial as a first-line therapy for PTLD.
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. makoto-h@pedsurg.med.kyushu-u.ac.jp
Makoto
M
Hayashida
Keiko
K
Ogita
Toshiharu
T
Matsuura
Yukiko
Y
Takahashi
Yuko
Y
Nishimoto
Shouichi
S
Ohga
Toshiro
T
Hara
Yuji
Y
Soejima
Akinobu
A
Taketomi
Yoshihiko
Y
Maehara
Kenichi
K
Kohashi
Masazumi
M
Tsuneyoshi
Tomoaki
T
Taguchi
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology*; D012074:Remission Induction; D000069283:Rituximab; D013997:Time Factors
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab