title: Calcineurin inhibitor-free graft-versus-host disease prophylaxis with sirolimus and mycophenolate mofetil in a second allogeneic stem cell transplantation for engraftment failure and rituximab-refractory Epstein-Barr virus-induced posttransplant lymphoproliferative disease.
abstract: Posttransplant lymphoproliferative disease (PTLD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. We describe here the case of a boy with history of induction failure of a T-cell acute lymphoblastic leukemia, who presented a life-threatening situation of nonengraftment and rituximab-refractory PTLD after the first hematopoietic stem cell transplantation. We decided to use an unusual strategy of combining a nonmyeloablative conditioning (fludarabine and cyclophosphamide) with a calcineurin inhibitor-free GvHD prophylaxis (sirolimus and mycophenolate mofetil). This strategy had permitted the control of an Epstein-Barr virus PLTD in umbilical cord blood transplantation without further reactivation.
authors: *Department of Pediatrics, Division of Hematology-Oncology, Centre de Cancérologie Charles-Bruneau †Department of Pharmacy ‡Department of Pediatrics, Division of Infectious Disease §Department of Microbiology, Laboratory of Molecular Virology and Serology, University of Montreal, Sainte Justine Hospital, Montreal, Canada.
authors: Francesco
authors: F
authors: Ceppi
authors: Michel
authors: M
authors: Duval
authors: Pierre
authors: P
authors: Teira
authors: Roxane
authors: R
authors: Therrien
authors: Philippe
authors: P
authors: Ovetchkine
authors: Brigitte
authors: B
authors: Mallette
authors: Henrique
authors: H
authors: Bittencourt
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000494:pharmacology; D019703:Calcineurin; D002648:Child; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000628:therapy*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D000069283:Rituximab; D020123:Sirolimus / Q000627:therapeutic use*; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab; D019703:Calcineurin; D014740:Vidarabine; D009173:Mycophenolic Acid; C024352:fludarabine; D020123:Sirolimus