title: Radioimmunotherapy ((90) Y-Ibritumomab Tiuxetan) for Posttransplant Lymphoproliferative Disorders After Prior Exposure to Rituximab.
abstract: Posttransplantation lymphoproliferative disorders (PTLDs) are life-threatening complications after solid organ and hematopoietic stem cell transplantation. Only half of CD20-positive PTLDs respond to rituximab monotherapy, and outcomes remain poor for patients with relapsed/refractory disease, especially those who do not qualify for an anthracycline containing regimen due to frailty or comorbidities. Radioimmunotherapy (RIT) might be an option in this particular setting. We report a panel of eight patients with rituximab refractory/relapsed CD20-positive PTLDs including three ineligible for subsequent CHOP-like chemotherapy who received (90) Y-Ibritumomab tiuxetan as a single agent (n = 7) or combined to chemotherapy (n = 1). Five out of eight patients were kidney transplant recipients, while 2/8 had a liver transplant and 1/8 had a heart transplant. Patients received a median of two previous therapies. Overall response rate was 62.5%. Importantly, all responders achieved complete response. At a median follow-up of 37 months [5; 84], complete response was ongoing in four patients. Toxicity was predominantly hematological and easily manageable. No graft rejection was noticed concomitantly or following RIT administration despite immunosuppression reduction after diagnosis of PTLDs. This report emphasizes the potential efficiency of salvage RIT for early rituximab refractory PTLDs without any unexpected toxicity.
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: J
authors: J
authors: Rossignol
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: L
authors: L
authors: Terriou
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: D
authors: D
authors: Robu
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: C
authors: C
authors: Willekens
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: B
authors: B
authors: Hivert
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: L
authors: L
authors: Pascal
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: R
authors: R
authors: Guieze
authors: Division of Hematology and Oncology, Department of Medicine, Ev. Diakonie-Krankenhaus, Bremen, Germany.
authors: R
authors: R
authors: Trappe
authors: Service de médecine nucléaire, CHRU de Lille, Lille, France.
authors: C
authors: C
authors: Baillet
authors: Service de médecine nucléaire, CHRU de Lille, Lille, France.
authors: D
authors: D
authors: Huglo
authors: Service des Maladies du Sang, CHRU de Lille, Lille, France.
authors: F
authors: F
authors: Morschhauser
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D016499:Radioimmunotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000494:pharmacology*; D016879:Salvage Therapy; D066027:Transplant Recipients
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069283:Rituximab; C422802:ibritumomab tiuxetan
keywords: Cancer; clinical research; complication: malignant; hematology; immune deficiency; malignancy; neoplasia: chemotherapy; oncology; organ transplantation in general; posttransplant lymphoproliferative disorder (PTLD); practice