title: High-dose intravenous rituximab for multifocal, monomorphic primary central nervous system posttransplant lymphoproliferative disorder.
abstract: Primary central nervous system (CNS) posttransplant lymphoproliferative disorder (PTLD) is a well-recognized but rare complication of solid organ transplantation. Most of these disorders are B-cell in origin and generally carry poor prognosis. Rituximab, an anti-CD20 monoclonal antibody, has been used effectively in patients with systemic PTLD. However, its role in primary CNS PTLD is doubtful because it does not cross blood-brain barrier efficiently (<5%). Also, mechanisms, by which rituximab operates are not optimally effective in CNS. Here, we describe a renal transplant patient with monomorphic, multifocal, CD20-positive, primary B-cell CNS PTLD, who was treated with high-dose intravenous rituximab given in dose-escalation protocol, which has been used effectively for the patients with chronic lymphocytic leukemia. At 1-year follow-up, magnetic resonance imaging (MRI) showed complete resolution. High-dose rituximab may have a role in highly selected patients with primary CNS PTLD.
authors.affiliation: Department of Medicine, St. Vincent Hospital, 8333 Naab Road, Suite 300, Indianapolis, IN 46260, USA.
authors.forename: A
authors.initials: A
authors.lastname: Patrick
authors.forename: A
authors.initials: A
authors.lastname: Wee
authors.forename: A
authors.initials: A
authors.lastname: Hedderman
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Weiss
authors.forename: M
authors.initials: M
authors.lastname: Govani
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000378:metabolism; D002493:Central Nervous System Diseases / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D019309:Epstein-Barr Virus Nuclear Antigens / Q000378:metabolism; D005260:Female; D005921:Glomerulonephritis / Q000601:surgery; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D016030:Kidney Transplantation / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D019309:Epstein-Barr Virus Nuclear Antigens; D007155:Immunologic Factors; D000069283:Rituximab