Long‐term remission in an adult heart transplant recipient with advanced Burkitt’s lymphoma post‐transplant lymphoproliferative disorder after anthracycline‐free chemotherapy: A case report and literature review

Abstract

Incidence of Burkitt's lymphoma post‐transplant lymphoproliferative disorder (BL‐PTLD) in solid organ transplant (SOT) recipients in 1.4%‐1.6% with unknown cure rate. We report a case of Epstein‐Barr virus (EBV) positive, late‐onset BL‐PTLD in a 24‐year‐old EBV donor positive/recipient negative female. This is the first reported case of advanced BL‐PTLD post‐heart transplant in an adult. This is also the first reported case of treatment of advanced BL‐PTLD in a heart transplant recipient with a combined chemotherapy regimen without anthracyclines to avoid cardiotoxicity. The patient received 6 cycles of R‐COEP (rituximab with cyclophosphamide, vincristine, etoposide, prednisone) over 6 months and subsequently 3 cycles of high‐dose methotrexate (MTX) over 3 months for CNS prophylaxis. She remains without evidence of disease at 19 months post‐treatment. This case demonstrates that an anthracycline‐free regimen can be the therapy option for patients with BL‐PTLD after heart transplantation.

Burkitt lymphoma after solid‐organ transplant: Treatment and outcomes in the paediatric PTLD collaborative

“…For example, DLBCL‐type M‐PTLD may respond well to reduction of immunosuppression (RIS) and/or specific anti‐B‐cell immunotherapy, such as rituximab, and adequate treatment does not always require chemotherapy 13–17 . However, published data about treatment and outcomes specifically for PSOT‐BL are limited by the small number of patients with PSOT‐BL compared to other types of M‐PTLD 3,4,12,18–20 . In the limited available data in children, patients with PSOT‐BL were often grouped with other types of PTLD despite its more aggressive clinical phenotype 13,21 .…”

“…[13][14][15][16][17] However, published data about treatment and outcomes specifically for PSOT-BL are limited by the small number of patients with PSOT-BL compared to other types of M-PTLD. 3,4,12,[18][19][20] In the limited available data in children, patients with PSOT-BL were often grouped with other types of PTLD despite its more aggressive clinical phenotype. 13,21 This study aimed to retrospectively identify paediatric patients with PSOT-BL in a multicentre collaborative to describe treatment approaches and clinical outcomes.…”