Abstract | BACKGROUND: Recommended first-line treatment for posttransplant lymphoproliferative disorder (PTLD) is reduction in immunosuppressive therapy, irrespective of histopathological type. Second-line treatment with chemotherapy is generally reserved for tumors that fail to respond to reduced immunosuppression. In view of the similarities between monomorphic PTLD and non-Hodgkin's lymphoma in the general population, our policy is to treat monomorphic PTLD with anthracycline-based chemotherapy as first-line treatment. METHODS: A retrospective single-center analysis of 18 adults who developed PTLD following liver or kidney transplantation was undertaken, with particular emphasis on tumor histology, treatment received, and clinical outcome. RESULTS: Of the 18 patients with PTLD, 13 had high-grade malignant lymphoma on diagnostic biopsy and received anthracycline-based chemotherapy and reduction in immunosuppression as first-line therapy. Nine (69%) of the 13 patients achieved complete remission and eight (62%) remained in complete remission five years after diagnosis. There was no graft loss from rejection or drug toxicity. Four (22%) patients had polymorphic PTLD on diagnostic biopsy (of which two were re-classified as monomorphic) and one had a low-grade malignant lymphoma. All five patients were treated by reduction in immunosuppression without chemotherapy and were in complete remission at a median of two years after diagnosis. Overall, complete remission was seen in 14 out of 18 patients (78%) at one year following diagnosis. CONCLUSION: The use of anthracycline-based chemotherapy and reduction of immunosuppression as first-line treatment in adults with monomorphic PTLD is well tolerated and achieves sustained complete remission in around 70% of patients with a low risk of graft loss.
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Authors | Anna L Taylor, Kristian M Bowles, Christopher J Callaghan, Jenny Z Wimperis, John W Grant, Robert E Marcus, J Andrew Bradley |
Journal | Transplantation
(Transplantation)
Vol. 82
Issue 3
Pg. 375-81
(Aug 15 2006)
ISSN: 0041-1337 [Print] United States |
PMID | 16906036
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Aged
- Anthracyclines
(therapeutic use)
- Biopsy
- Female
- Humans
- Kidney Transplantation
- Lymphoma
(complications, drug therapy, pathology)
- Lymphoproliferative Disorders
(complications, drug therapy, pathology)
- Male
- Middle Aged
- Survival Rate
- Time Factors
- Treatment Outcome
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