title: Successful treatment of systemic and central nervous system post-transplant lymphoproliferative disorder without the use of high-dose methotrexate or radiation.
abstract: Post-transplant lymphoproliferative disorder (PTLD) describes a spectrum of conditions with highest incidence in the first year post-solid organ transplant in pediatric patients. Central nervous system (CNS) involvement with PTLD carries high mortality risk with no consensus on optimal therapeutic regimen. We present the case of a 7-year old heart transplant patient diagnosed with widespread monomorphic, CD20+, Epstein-Barr virus-positive PTLD, including CNS involvement. In addition to immunosuppression reduction and rituximab, she was treated with multiagent systemic and intrathecal chemotherapy. She achieved a prompt and complete clinical and radiologic remission, which has been sustained for over 46 months since diagnosis.
authors: Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California.
authors: Sidharth
authors: S
authors: Mahapatra
authors: Clifford C
authors: CC
authors: Chin
authors: Andrei
authors: A
authors: Iagaru
authors: Amy
authors: A
authors: Heerema-McKenney
authors: Clare J
authors: CJ
authors: Twist
mesh_terms: D001853:Bone Marrow / Q000473:pathology; D002490:Central Nervous System / Q000473:pathology; D002648:Child; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use*
chemical_list: D008727:Methotrexate
keywords: Epstein-Barr virus (EBV); central nervous system post-transplant lymphoproliferative disorder (CNS PTLD); chemotherapy; heart transplant