Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients

Thierry Berney, Spiros Delis, Tomoaki Kato, Seigo Nishida, Naveen K Mittal, Juan Madariaga, David Levi, Jose R. Nery, Robert E. Cirocco, Barry Gelman, Philip Ruiz, Andreas G. Tzakis

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Abstract

Background. Posttransplant Epstein-Barr virus-associated B-cell lymphoproliferative disease (PTLD) has a higher incidence after intestinal transplantation than after transplantation of other solid organs and is associated with a high mortality. A new anti-CD20 monoclonal antibody, rituximab, has shown efficiency in the treatment of B-cell lymphoma, including PTLD, but its use has not yet been reported in intestinal transplant recipients. Methods. We retrospectively reviewed five patients who were diagnosed with PTLD from March 1999 to August 2001, after intestinal transplantation. These patients were primarily managed with rituximab, associated with reduction or interruption of immunosuppression and antiviral therapy with ganciclovir and cytomegalovirus immune globulin. Rituximab was administered at weekly doses of 375 mg/m2 until full remission was ascertained, and the interval between doses was then increased. No patient received chemotherapy. Results. One patient had nonmalignant lymphoproliferation, and four had malignant PTLD, as assessed by histopathology and monoclonality of the tumor. Two pediatric patients had severe generalized disease. All patients had received OKT3 as treatment of rejection before developing PTLD. All tumors showed proliferation of CD20+ cells and were positive for Epstein-Barr virus by in situ hybridization. All patients responded to rituximab therapy and have achieved full remission with a follow-up of 3 to 30 (median, 8) months. Conclusion. Prolonged rituximab treatment, in association with reduction of immunosuppression and antiviral therapy, is highly efficient as part of the firstline treatment of CD20+ B-cell PTLD after intestinal transplantation.

Original languageEnglish (US)
Pages (from-to)1000-1006
Number of pages7
JournalTransplantation
Volume74
Issue number7
StatePublished - Oct 15 2002
Externally publishedYes

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Transplantation
Human Herpesvirus 4
Immunosuppression
Therapeutics
Antiviral Agents
B-Lymphocytes
Muromonab-CD3
Ganciclovir
B-Cell Lymphoma
Rituximab
Transplant Recipients
Cytomegalovirus
In Situ Hybridization
Immunoglobulins
Neoplasms
Monoclonal Antibodies
Cell Proliferation
Pediatrics
Drug Therapy
Mortality

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Berney, T., Delis, S., Kato, T., Nishida, S., Mittal, N. K., Madariaga, J., ... Tzakis, A. G. (2002). Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients. Transplantation, 74(7), 1000-1006.

Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients. / Berney, Thierry; Delis, Spiros; Kato, Tomoaki; Nishida, Seigo; Mittal, Naveen K; Madariaga, Juan; Levi, David; Nery, Jose R.; Cirocco, Robert E.; Gelman, Barry; Ruiz, Philip; Tzakis, Andreas G.

In: Transplantation, Vol. 74, No. 7, 15.10.2002, p. 1000-1006.

Research output: Contribution to journalArticle

Berney, T, Delis, S, Kato, T, Nishida, S, Mittal, NK, Madariaga, J, Levi, D, Nery, JR, Cirocco, RE, Gelman, B, Ruiz, P & Tzakis, AG 2002, 'Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients', Transplantation, vol. 74, no. 7, pp. 1000-1006.
Berney, Thierry ; Delis, Spiros ; Kato, Tomoaki ; Nishida, Seigo ; Mittal, Naveen K ; Madariaga, Juan ; Levi, David ; Nery, Jose R. ; Cirocco, Robert E. ; Gelman, Barry ; Ruiz, Philip ; Tzakis, Andreas G. / Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients. In: Transplantation. 2002 ; Vol. 74, No. 7. pp. 1000-1006.
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AU - Berney, Thierry

AU - Delis, Spiros

AU - Kato, Tomoaki

AU - Nishida, Seigo

AU - Mittal, Naveen K

AU - Madariaga, Juan

AU - Levi, David

AU - Nery, Jose R.

AU - Cirocco, Robert E.

AU - Gelman, Barry

AU - Ruiz, Philip

AU - Tzakis, Andreas G.

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N2 - Background. Posttransplant Epstein-Barr virus-associated B-cell lymphoproliferative disease (PTLD) has a higher incidence after intestinal transplantation than after transplantation of other solid organs and is associated with a high mortality. A new anti-CD20 monoclonal antibody, rituximab, has shown efficiency in the treatment of B-cell lymphoma, including PTLD, but its use has not yet been reported in intestinal transplant recipients. Methods. We retrospectively reviewed five patients who were diagnosed with PTLD from March 1999 to August 2001, after intestinal transplantation. These patients were primarily managed with rituximab, associated with reduction or interruption of immunosuppression and antiviral therapy with ganciclovir and cytomegalovirus immune globulin. Rituximab was administered at weekly doses of 375 mg/m2 until full remission was ascertained, and the interval between doses was then increased. No patient received chemotherapy. Results. One patient had nonmalignant lymphoproliferation, and four had malignant PTLD, as assessed by histopathology and monoclonality of the tumor. Two pediatric patients had severe generalized disease. All patients had received OKT3 as treatment of rejection before developing PTLD. All tumors showed proliferation of CD20+ cells and were positive for Epstein-Barr virus by in situ hybridization. All patients responded to rituximab therapy and have achieved full remission with a follow-up of 3 to 30 (median, 8) months. Conclusion. Prolonged rituximab treatment, in association with reduction of immunosuppression and antiviral therapy, is highly efficient as part of the firstline treatment of CD20+ B-cell PTLD after intestinal transplantation.

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