Abstract |
Post-transplant lymphoproliferative disorders (PTLD) are severe complications after solid organ transplantation with no consensus on best treatment practice. Chemotherapy is a therapeutic option with a high response and a significant relapse rate leading to a low long-term tolerance rate. Currently, most centres use anthracycline-based drug combinations, such as CHOP ( cyclophosphamide, doxorubicin, vincristine and prednisone). We assessed the efficacy and safety of a dose-adjusted ACVBP ( doxorubicin reduced to 50 mg/m(2), cyclophosphamide adjusted to renal function, vindesine, bleomycin, prednisone) regimen in patients failing to respond to a reduction in immunosuppressive therapy. Favourable responses were observed in 24 (73%) of the 33 treated patients. Fourteen (42%) patients died, mostly from PTLD progression. Actuarial survival was 60% at 5 years and 55% at 10 years. Survival prognostic factors were: number of involved sites (P = 0.007), clinical stage III/IV (P = 0.004), bulky tumour (P < 0.0001), B symptoms (P = 0.03), decreased serum albumin (P = 0.03) and poor performance status (P = 0.06). Both the international and the PTLD prognostic index were predictive for survival (P = 0.001 and P = 0.002, respectively). Overall 128 cycles were given. Grade 3 or 4 neutropenia was recorded after 26 (20%) chemotherapy cycles in 19 (58%) patients. Forty-one (32%) infections were recorded in 26 (79%) patients. This study demonstrated that an individual dose-adjustment of ACVBP regimen was manageable in PTLD patients and favourably impacted on long-term survival.
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Authors | Cécile Fohrer, Sophie Caillard, Argyro Koumarianou, Bernard Ellero, Marie-Lorraine Woehl-Jaeglé, Carole Meyer, Eric Epailly, Marie-Pierre Chenard, Bruno Lioure, Shanti Natarajan-Ame, Frédéric Maloisel, Philippe Lutun, Romain Kessler, Bruno Moulin, Jean-Pierre Bergerat, Philippe Wolf, Raoul Herbrecht |
Journal | British journal of haematology
(Br J Haematol)
Vol. 134
Issue 6
Pg. 602-12
(Sep 2006)
ISSN: 0007-1048 [Print] England |
PMID | 16889621
(Publication Type: Journal Article)
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Chemical References |
- Bleomycin
- Vincristine
- Doxorubicin
- Cyclophosphamide
- Vindesine
- Prednisone
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Topics |
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects, therapeutic use)
- Bacterial Infections
(etiology, mortality)
- Bleomycin
(adverse effects, therapeutic use)
- Cyclophosphamide
(administration & dosage, adverse effects, therapeutic use)
- Disease-Free Survival
- Doxorubicin
(administration & dosage, adverse effects, therapeutic use)
- Drug Administration Schedule
- Female
- Humans
- Lymphoproliferative Disorders
(drug therapy, mortality)
- Male
- Middle Aged
- Organ Transplantation
- Postoperative Complications
(drug therapy, mortality)
- Prednisone
(administration & dosage, adverse effects, therapeutic use)
- Survival Rate
- Treatment Outcome
- Vincristine
(administration & dosage)
- Vindesine
(adverse effects, therapeutic use)
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