CHOP-21 for the treatment of post-transplant lymphoproliferative disorders following solid organ transplantation

Choquet, Sylvain; Trappe, Ralf Ulrich; Leblond, Véronique; Jäger, Ulrich; Davi, Frédéric; Oertel, Stephan

doi:10.3324/haematol.10595

Cited by 142 publications

(99 citation statements)

References 10 publications

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“…Standard cyclophosphamide, doxorubicin, vincristine, prednisone regimen in adult patients with LPD can achieve an overall response rate of 65% and median overall and progression-free survivals of 13.9 and 42 months, respectively. 43 In patients who progress after initial maneuvers, options include T-cell therapies using EBV-specific cytotoxic T lymphocyte lines generated using EBV-transformed lymphoblastoid B-cell lines. 13,44 However, despite their efficacy and good safety profile, the use of cytotoxic T lymphocytes is still restricted to few transplant centers worldwide.…”

Section: Discussionmentioning

confidence: 99%

Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation

et al. 2011

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This single centre study assessed the incidence, kinetics and predictive factors of Epstein-Barr Virus (EBV) reactivation and EBV-related lymphoproliferative diseases (LPDs) in 175 consecutive patients who received a reduced-intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT). The cumulative incidence of EBV reactivation at 6 months after allo-HSCT defined as an EBV PCR load above 1000 copies of EBV DNA/10 5 cells was 15%, and none of these patients experienced any sign or symptom of LPD. A total of 17 patients, who had EBV DNA levels exceeding 1000 copies/10 5 cells on two or more occasions, were pre-emptively treated with rituximab. With a median follow-up of 655 (range, 92-1542) days post allo-HSCT, there was no statistically significant difference in term of outcome between those patients who experienced an EBV reactivation and those who did not. In multivariate analysis, the use of antithymocyte globulin as part of the RIC regimen was the only independent risk factor associated with EBV reactivation (relative risk ¼ 4.9; 95% confidence interval, 1.1-21.0; P ¼ 0.03). We conclude that patients undergoing RIC allo-HSCT using anti-thymocyte globulin as part of the preparative regimen are at higher risk for EBV reactivation. However, this did not impact on outcome, as quantitative monitoring of EBV viral load by PCR and preemptive rituximab therapy allowed for significantly reducing the risk of EBV-related LPD.

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Section: Discussionmentioning

confidence: 99%

Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation

et al. 2011

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“…The response rate and overall survival time were widely variable on retrospective analysis, and few prospective studies have been reported so far [62][63][64]. The best time and the best chemotherapy schedule for these patients remain controversial.…”

Section: Table 3 Ebv-associated Lymphoproliferative Disorders Ebv-asmentioning

confidence: 99%

EBV-Associated Lymphoproliferative Disorders: Classification and Treatment

2008

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Since its discovery as the first human tumor virus, Epstein-Barr virus (EBV) has been implicated in the development of a wide range of B-cell lymphoproliferative disorders, including Burkitt's lymphoma, classic Hodgkin's lymphoma, and lymphomas arising in immunocompromised individuals (post-transplant and HIV-associated lymphoproliferative disorders). T-cell lymphoproliferative disorders that have been reported to be EBV associated include a subset of peripheral T-cell lymphomas, angioimmunoblastic Tcell lymphoma, extranodal nasal type natural killer/ T-cell lymphoma, and other rare histotypes. EBV encodes a series of products interacting with or exhibiting homology to a wide variety of antiapoptotic molecules, cytokines, and signal transducers, hence promoting EBV infection, immortalization, and transformation. However, the exact mechanism by which EBV promotes oncogenesis is an area of active debate. The focus of this review is on the pathology, diagnosis, classification, and pathogenesis of EBVassociated lymphomas. Recent advances in EBV cellbased immunotherapy, which is beginning to show promise in the treatment of EBV-related disorders, are discussed. The Oncologist 2008;13:577-585

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“…The 5-year survival rate was 24% for those receiving CHOP and 5% for those receiving single-agent therapy [55]. A more recent-though much smaller-case series from 2007 reported a median follow-up of Ͼ8 years for 26 adults with PTLD treated with CHOP after initial progression [56]. The overall response rate (ORR) was 65%, the median overall survival time was 13.9 months, and the progression-free survival time was 42 months.…”

Section: Treatmentmentioning

confidence: 92%

Malignancy After Solid Organ Transplantation: An Overview

2008

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Disclosure:This article discusses the use of acitretin (manufactured by Connetics) for prophylaxis of non-melanoma skin cancers; cyclophosphamide * (Bristol-Myers Squibb), adriamycin * (Pharmacia), prednisone * (Pfizer), vindesine (Lilly/EG Labo; not available in the U.S.), rituximab * (Genentech), and monoclonal anti-IL-6-antibody (multiple manufacturers) for post-transplant lymphoproliferative disorder (PTLD) (clinical trial); vincristine * (Lilly/Gensia Sicor) and bleomycin * (Bristol-Myers Squibb) for PTLD and Kaposi's sarcoma (KS); liposomal daunorubicin (Gilead) for KS (indicated for HIV-associated KS); paclitaxel (BristolMyers Squibb) for KS (indicated for AIDS-associated KS); imatinib (Novartis) and bevacizumab (Genentech) for KS; and matrix metalloproteinase inhibitor COL-3 (CollaGenex) for KS (clinical trial). ( * Drugs marked with asterisks are indicated for use in malignant lymphomas generally, but no specific mention is made of PTLD.)The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers. LEARNING OBJECTIVESAfter completing this course, the reader should be able to:1. Describe the most common malignancies encountered after solid organ transplantation.2. Discuss the pathogenesis of malignancy after solid organ transplantation. Administer standard treatment for common post-solid organ transplantation malignancies.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACT CASE PRESENTATIONA 49-year-old man with no prior medical history initially presented with severe dyspnea progressive over 6 months.The patient underwent an open-lung biopsy that confirmed the diagnosis of idiopathic pulmonary fibrosis. He was assessed for lung transplantation. An extensive pretransplant

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CHOP-21 for the treatment of post-transplant lymphoproliferative disorders following solid organ transplantation

Cited by 142 publications

References 10 publications

Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation

Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation

EBV-Associated Lymphoproliferative Disorders: Classification and Treatment

Malignancy After Solid Organ Transplantation: An Overview

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