Mini‐BEAM and autologous hematopoietic stem‐cell transplant for treatment of post‐transplant lymphoproliferative disorders

Abstract

Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of lymphoid proliferative diseases seen as result of immunosuppression in recipients of solid organ or hematopoietic stem-cell transplantation. Options of treatment include reduction or discontinuation of immunosuppressive agents, antiviral drugs, rituximab, chemotherapy, and radiation. We report two unique cases of PTLD (CNS and plasmacytoma-like) treated successfully with salvage chemotherapy, mini-BEAM chemotherapy, and autologous stem-cell transplant. In both cases, patients were also treated with sirolimus and prednisone as immunosuppression, and neither patient rejected their solid organ transplants. With over 30 months of follow-up, both patients remain in complete remission with excellent allograft function. Am.

Management of post‐transplant lymphoproliferative disorders

“…There have been reports in the literature of success with the use of salvage regimens such as rituximab and ICE (ifosfamide, carboplatin and etoposide), GEMOX (gemcitabine and oxaliplatin) and ESHAP (etoposide, solu‐medrol, high‐dose cytarabine and cisplatin) among others, which have been followed by high‐dose chemotherapy with autologous stem cell rescue with some success. However, these data are limited to case reports (Komrokji et al , ; Malhotra et al , ). In the rare event that PTLD is localized and not responsive to RI or rituximab, local treatment measures such as surgery or radiotherapy can be considered.…”

Posttransplant Lymphoproliferative Disorder After Clinical Islet Transplantation: Report of the First Two Cases

“…HD-MTX is an accepted treatment for fit nontransplantation patients with normal renal function, and chemosensitive patients can achieve prolonged remission with consolidative ASCT (35). Although many transplant patients are poor candidates for these regimens due to comorbidities, SOT patients have been treated successfully with HD-MTX for CNS PTLD (36,37) and ASCT for relapsed PTLD (38)(39)(40). Our report represents both the first case of secondary CNS relapse of PTLD successfully treated with HD-MTX and consolidative ASCT and the first islet transplant patient with relapsed PTLD treated with ASCT.…”

Post-Transplant Lymphoproliferative Disorders

“…Case reports of successful autologous stem cell transplants in patients with chemotherapy-sensitive PTLD at relapse have been reported with preservation of graft function [44]. Most patients with refractory PTLD, however, are not candidates for salvage high-dose chemotherapy with stem cell support because of refractory disease and/or the comorbidities associated with organ dysfunction.…”