Lymphomas in heart transplant recipients: do antivirals protect against the neoplastic effect of anti-CD3 monoclonal antibody?
OBJECTIVE
After cardiac allograft vasculopathy, tumors are the second leading cause of death among heart transplantation (HT) patients after the first year. Lymphomas are tumors of lymphocytic origin whose development has been associated with the use of anti-CD3 monoclonal antibody (OKT3). Some studies suggest that the use of acyclovir could counteract this effect. Our aim was to investigate the impact of gancyclovir on OKT3 and lymphoma development after HT.


METHODS
We included all 239 HTs performed in our center from 1989 to 2002. We divided patients into those who received gancyclovir treatment (prophylaxis, pre-emptive therapy, or for cytomegalovirus infection) versus those who did not receive this agent at any time during follow-up (88 vs 151 patients). The statistical methods were Student's t and chi-square tests.


RESULTS
There were no differences in the baseline characteristics of the patients--gender, recipient age, etiology leading to HT, diabetes, and dyslipidemia--except for a higher rate of hypertension among the group who did not receive gancyclovir (73.7 vs 60.2%; P=.03). None of the 7 patients who developed lymphomas during the follow-up received gancyclovir (0 vs 4.6%; P=.040).


CONCLUSIONS
Antivirals may have a relevant role to neutralize potential neoplastic effects (especially lymphomas) associated with the use of OKT3 induction therapy.
Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain. igsania@comv.es
I J
IJ
Sánchez-Lázaro
L
L
Almenar
L
L
Martínez-Dolz
J
J
Agüero
F
F
Buendía
J
J
Navarro
R
R
Raso
A
A
Salvador
D000911:Antibodies, Monoclonal / Q000276:immunology*; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017252:CD3 Complex / Q000276:immunology*; D015774:Ganciclovir / Q000494:pharmacology / Q000627:therapeutic use*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008223:Lymphoma / Q000209:etiology* / Q000517:prevention & control
D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D017252:CD3 Complex; D015774:Ganciclovir