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.

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.…”

Double-hit monomorphic B-cell lymphoma after liver transplantation

“…The option of haematopoietic stem cell transplant (HSCT) was not offered considering our patient’s age, comorbidities and lack of clinical trial data supporting its use. Even though, there are rare case reports showing the successful use of HSCT 20 21…”