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Successful treatment of Rituximab-resistant Epstein-Barr virus-associated post-transplant lymphoproliferative disorder using R-CHOP.

Abstract
Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (EBV-PTLD) is a complication of hematopoietic stem cell transplantation (HSCT). Standard initial treatment of patients with EBV-PTLD includes administration of rituximab or dose reduction of a calcineurin inhibitor. We report successful chemotherapeutic treatment of rituximab-resistant EBV-PTLD after HSCT in a patient with severe aplastic anemia (AA). A 38-year-old woman with antithymocyte globulin (ATG)-resistant severe AA received bone marrow transplantation from an unrelated donor (human leukocyte antigen-DR single-locus mismatch). The conditioning regimen included fludarabine, cyclophosphamide, ATG, and total body irradiation, and prophylaxis for graft-versus-host disease consisted of short methotrexate and tacrolimus. Neutrophil engraftment occurred on day 21. Left cervical lymph node swelling was observed after day 45, and analysis of a biopsy specimen revealed EBV-PTLD and a high blood EBV load (56,000 copies). The patient was treated with rituximab 4 times per week, but the lymphadenopathy continued and the blood EBV load increased to 96,000 copies. Half-dose treatment with rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone (R-CHOP) was initiated on day 71. After 32 days of treatment with R-CHOP, the patient's neutrophil level was restored to > 0.5 × 10(9)/L and both the lymphadenopathy and the blood EBV load (< 100 copies) were rapidly reduced. Although chemotherapy is not preferred soon after HSCT, it may be an effective strategy for treating patients with rituximab-resistant EBV-PTLD.
AuthorsTakuro Kuriyama, Noriaki Kawano, Kiyoshi Yamashita, Akira Ueda
JournalJournal of clinical and experimental hematopathology : JCEH (J Clin Exp Hematop) Vol. 54 Issue 2 Pg. 149-53 ( 2014) ISSN: 1880-9952 [Electronic] Japan
PMID25318948 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Antibodies, Monoclonal, Murine-Derived
  • R-CHOP protocol
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone
Topics
  • Adult
  • Anemia, Aplastic (complications, therapy)
  • Antibodies, Monoclonal, Murine-Derived (therapeutic use)
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Cyclophosphamide (therapeutic use)
  • Doxorubicin (therapeutic use)
  • Epstein-Barr Virus Infections (complications, diagnosis)
  • Female
  • Hematopoietic Stem Cell Transplantation (adverse effects)
  • Herpesvirus 4, Human
  • Humans
  • Lymphoproliferative Disorders (diagnosis, drug therapy, etiology)
  • Prednisone (therapeutic use)
  • Rituximab
  • Treatment Outcome
  • Vincristine (therapeutic use)

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