title: Monotherapy with anti-CD20 monoclonal antibody in a heart transplant recipient with sick sinus syndrome and posttransplantation lymphoproliferative disorder: a case report.
abstract: Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation, with an incidence of 0.8% to 20% in heart transplant (HTx) recipients, and standard treatment may be too toxic in some cases. Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies and has been demonstrated effective in combination with chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone). Cardiotoxicity with CHOP remains a major concern for treating HTx recipients with PTLD, however. We present a case of an HTx recipient with sick sinus syndrome and PTLD who was successfully treated with rituximab alone, avoiding the cardiotoxicity of CHOP. The cardiotoxicity induced by CHOP should be kept in mind in HTx recipients with PTLD, especially when there is an existing heart problem in such recipients. Monotherapy with rituximab can be considered a safe choice.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Hsiang-Yu
authors.initials: HY
authors.lastname: Yang
authors.forename: Hung-Yen
authors.initials: HY
authors.lastname: Ke
authors.forename: Gou-Jieng
authors.initials: GJ
authors.lastname: Hong
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Tsai
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lin
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols; D000075202:Contraindications; D003520:Cyclophosphamide; D004317:Doxorubicin; D006084:Graft Rejection / Q000188:drug therapy; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone; D000069283:Rituximab; D012804:Sick Sinus Syndrome / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014750:Vincristine
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone