Chemoimmunotherapy and Withdrawal of Immunosupression for Monomorphic Posttransplant Lymphoproliferative Disorders

详细信息    查看全文

• 作者：Nikolai Podoltsev ; Bingnan Zhang ; Xiaopan Yao ; Ivan Bustillo ; Yanhong Deng ; Dennis L. Cooper
• 关键词：Graft loss ; Organ rejection ; Rituximab ; Solid organ transplantation ; Treatment-related mortality
• 刊名：Clinical Lymphoma Myeloma and Leukemia
• 出版年：December, 2013
• 年：2013
• 卷：13
• 期：6
• 页码：716-720
• 全文大小：297 K

文摘

Background

Monomorphic PTLDs are the most aggressive type of PTLD occurring after SOT. Current guidelines for treatment suggest a stepwise approach that includes a reduction of immunosuppression (RIS) with or without rituximab, followed by chemotherapy if there is no response. Nevertheless, recommendations regarding the extent and duration of RIS are nonstandardized and RIS as an initial strategy might be associated with an unacceptably high frequency of graft loss and disease progression.

Patients and Methods

We reviewed the outcome of a combination program of aggressive chemoimmunotherapy and complete withdrawal of immunosuppression in treating 22 patients with monomorphic PTLD between January 1995 and August聽2012.

Results

Twelve of 22 patients (55%) received CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) every 2 weeks (dose-dense CHOP-R) and 10 patients received other doxorubicin-based regimens. There was no treatment-related mortality. Complete response was seen in 91% of patients. Median OS was 9.61 years (95% confidence interval (CI), 5.21-10.74). Median progression-free survival was 5.39 years (95% CI, 2.10-10.74). The graft rejection rate was 18% (95% CI, 0.03-0.34).

Conclusion

The use of aggressive chemoimmunotherapy in combination with the withdrawal of immunosuppression approach yields excellent results and should be prospectively studied in a multiinstitutional setting.