title: Treatment of Recurrent Posttransplant Lymphoproliferative Disorder with Autologous Blood Stem Cell Transplant.
abstract: Background. Posttransplant lymphoproliferative disorders (PTLDs) occur after solid organ transplantation. Treatment guidelines include reduction in immunosuppression (RIS), radiation, rituximab, chemotherapy, and immunological agents. We present a rare case of recurrent diffuse large B-cell lymphoma presenting as a PTLD in a heart transplant patient treated with autologous blood stem cell transplant (ASCT) after failure of conventional therapy. Case Presentation. A 66-year-old male presented with a neck mass. He has a history of Hodgkin's disease status after staging laparotomy with splenectomy and heart transplantation due to dilated nonischemic cardiomyopathy 8 years prior to the development of PTLD. His examination was remarkable for right submandibular swelling. An excisional biopsy confirmed the diagnosis of diffuse large B-cell NHL. Patient received RIS, rituximab, chemotherapy, and radiation therapy with a complete remission. His lymphoma relapsed and he subsequently was treated with RICE salvage chemotherapy and consolidative high-dose chemotherapy with BEAC regimen followed by ASCT resulting in a complete remission. Conclusion. Patients with PTLD present a difficult therapeutic challenge. In this case, the patient's prior history of Hodgkin's disease, splenectomy, and a heart transplant appear to be unique features, the significance of which is unclear. ASCT might be a promising therapy for patients with relapsed or refractory PTLD.
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Malhotra
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA.
authors.forename: Ahmad K
authors.initials: AK
authors.lastname: Rahal
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA ; Heartland Cardiology, Heartland West, 9000 W. Central, Wichita, KS 67212, USA.
authors.forename: Hussam
authors.initials: H
authors.lastname: Farhoud
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA ; Cancer Center of Kansas, 818 N. Emporia, No. 403, Wichita, KS 67214, USA.
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Moore
authors.affiliation: Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA.
authors.forename: K James
authors.initials: KJ
authors.lastname: Kallail