Lymphomas occurring late after solid-organ transplantation

Abstract

We suggest that patients with late PTLDs and limited disease may benefit from local treatment. For patients who require chemotherapy, we suggest that it should be administered to minimize the risk of infection complications.

Successful Treatment of Rituximab-Resistant Epstein-Barr Virus-Associated Post-transplant Lymphoproliferative Disorder Using R-CHOP

“…With SOT, 63% of patients who developed localized EBV-PTLD improved with radiation therapy and 65-90% of patients with EBV-PTLD responded to standard CHOP or R-CHOP. [20][21][22] In pediatric patients with rituximab-resistant EBV-PTLD after SOT, there was an 83% overall response rate to low-dose chemotherapy (cyclophosphamide 600 mg/m 2 and prednisolone every 3 weeks for 6 cycles). 23 There are some reports of the treatment of EBV-PTLD after SOT or in pediatric patients, but there are only a few reports of treatment of EBV-PTLD after HSCT, especially during the early phase after HSCT.…”

Posttransplant Lymphoproliferative Disorders Following Solid Organ Transplantation

“…Multiple reports have shown that EBV-unrelated PTLD occurs later after SOT, most commonly after 3 to 5 years. (Dotti et al, 2002;MamzerBruneel et al, 2000) The incidence of EBV-unrelated PTLD has been increasing and may be explained by changing immunosuppressive regimens, longer survival after SOT, and an improvement in the diagnosis. (Nelson et al, 2000) EBV-related and EBV-unrelated PTLD usually have different clinical manifestations.…”

“…EBV-unrelated PTLD is usually a monomorphic disease with late manifestation and has historically carried a poor prognosis. (Dotti et al, 2002;Leblond et al, 1998;Nelson et al, 2000;Taylor et al, 2005) Recent data shows an improved response to treatment, which could be explained both by improvements in treatment strategies of the tumors and by improved supportive care. (Elstrom et al, 2006;Evens et al, 2010;Knight et al, 2009;Maecker et al, 2007) …”

Response to Peggs et al.

“…3 While an increase in EBVviral load does not invariably lead to PLTD, 4 it does identify a high-risk group of patients who will benefit from closer monitoring, and early intervention, for example, by the withdrawal of immunosuppression or treatment with rituximab. The outcome of established aggressive PTLD can be poor [5][6][7][8][9] and in order to attempt to improve the outcome for these patients, early intervention is imperative and is also much simpler in therapeutic terms.…”