title: Post-transplant lymphoproliferative disorder in children: recent outcomes and response to dual rituximab/low-dose chemotherapy combination.
abstract: PTLD is a major complication after transplantation. Treatment options for PTLD are not standardized, usually sequential, starting with reduction in immunosuppression. Recently, we have used a dual combination of rituximab and reduced dose chemotherapy (R/C) directly after failed RI. We retrospectively identified 30 pediatric PTLD cases across four organ systems at our center from 1995 to 2008. We assessed recent outcomes of PTLD in children, comparing the responses to different regimens. Two-yr failure-free survival was best in renal and heart recipients (80-88%), followed by liver (57%) and lung (0%). Of note, two patients were Epstein-Barr peripheral blood viral load low positive but tumor EBER negative. Three patients had no detectable viral load but were EBER positive. The R/C regimen (n = 8) had the highest CR rate (100%), low recurrence (12%) and lowest mortality (12%). Interferon (n = 4) had 75% CR, 33% recurrence and 25% mortality. Rituximab/prednisone (n = 5) had 80% CR, 50% recurrence and 20% mortality. Other chemotherapy (n = 7, including all 4 T-cell PTLDs) had 57% CR, 0% recurrence and 14% mortality. Direct dual R/C combination therapy after failed RI is effective and offers another treatment option for B-cell PTLD.
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine and Shands Children's Hospital, Gainesville, FL, USA.
authors.forename: Sushil
authors.initials: S
authors.lastname: Gupta
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Fricker
authors.forename: Regino P
authors.initials: RP
authors.lastname: González-Peralta
authors.forename: William B
authors.initials: WB
authors.lastname: Slayton
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Schuler
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D004854:Herpesvirus 4, Human / Q000378:metabolism; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab