title: Successful treatment of a classic Hodgkin lymphoma-type post-transplant lymphoproliferative disorder with tailored chemotherapy and Epstein-Barr virus-specific cytotoxic T lymphocytes in a pediatric heart transplant recipient.
abstract: CHL type is the least common major form of EBV-related PTLD but rarely occurs in pediatric recipients; development of CHL subsequent to other PTLD subtypes in the same transplant recipient is even more unusual. Because of its rarity, indications on the best treatment strategy are limited. Patients have been mostly treated with standard HL chemotherapy/radiotherapy, and prognosis seems more favorable than other monomorphic PTLDs. Herein, we describe a pediatric case of EBV-associated, stage IV-B, CHL arising in a heart allograft recipient eight yr after diagnosis of B-cell polymorphic PTLD. The patient was successfully treated with adjusted-dose HL chemotherapy and autologous EBV-specific CTL, without discontinuation of maintenance immunosuppression. At two yr from therapy completion, the patient is in CR with stable organ function. With this strategy, it may be possible to reproduce the good prognostic data reported for CHL-type PTLD, with decreased risk of organ toxicity or rejection.
authors.affiliation: Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Basso
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.forename: Lucia
authors.initials: L
authors.lastname: Calafiore
authors.forename: Laura
authors.initials: L
authors.lastname: Rubert
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiocchi
authors.forename: Marco
authors.initials: M
authors.lastname: Paulli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quartuccio
authors.forename: Ilaria
authors.initials: I
authors.lastname: Guido
authors.forename: Roberta
authors.initials: R
authors.lastname: Sebastiani
authors.forename: Giorgio Alberto
authors.initials: GA
authors.lastname: Croci
authors.forename: Claudia
authors.initials: C
authors.lastname: Beschi
authors.forename: Ida
authors.initials: I
authors.lastname: Nardiello
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ginevri
authors.forename: Chiara
authors.initials: C
authors.lastname: Cugno
authors.forename: Patrizia
authors.initials: P
authors.lastname: Comoli
mesh_terms: D001853:Bone Marrow / Q000473:pathology; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D004358:Drug Therapy; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000276:immunology; D016027:Heart Transplantation; D004854:Herpesvirus 4, Human; D006689:Hodgkin Disease / Q000628:therapy* / Q000821:virology; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000628:therapy* / Q000821:virology; D008297:Male; D013602:T-Lymphocytes, Cytotoxic / Q000166:cytology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Epstein-Barr virus; cytotoxic T lymphocytes; lymphoproliferative disorder; pediatric heart transplant