Related Experiment Videos
Aggressive treatment for postcardiac transplant lymphoproliferation
L J Swinnen1, G M Mullen, T J Carr
1Division of Hematology/Oncology, Loyola University Chicago, Maywood, IL 60153, USA.
Blood
|November 1, 1995
Summary
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after organ transplants. Aggressive chemotherapy, specifically ProMACE-CytaBOM, shows effectiveness in treating monoclonal PTLD in cardiac recipients when reduced immunosuppression fails.
Area of Science:
- Transplantation Immunology
- Oncology
- Infectious Diseases
Background:
- Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication following organ transplantation, affecting 2-6% of cardiac recipients.
- Current treatment strategies for PTLD are poorly defined, with high mortality rates (around 80%) reported for patients requiring chemotherapy, potentially due to concurrent immunosuppressive use.
Purpose of the Study:
- To retrospectively evaluate the clinical features and outcomes of cardiac transplant recipients with PTLD.
- To assess the efficacy and feasibility of a uniform treatment approach involving reduced immunosuppression followed by aggressive chemotherapy.
Main Methods:
- Retrospective analysis of 19 consecutive cardiac transplant recipients diagnosed with PTLD.
- Initial treatment involved reduced immunosuppression with acyclovir; refractory cases proceeded to combination chemotherapy, predominantly ProMACE-CytaBOM.
Main Results:
- Phenotypically polyclonal PTLD (n=6) presenting early (<6 months) showed poor response to reduced immunosuppression (1/4 responded), with most dying.
- Phenotypically monoclonal PTLD (n=13) presenting later (≥6 months) had limited success with initial immunosuppression reduction (0/8 CR).
- Subsequent chemotherapy (ProMACE-CytaBOM) in 8 patients with monoclonal PTLD achieved a 75% complete remission rate, with no relapses at median 38 months follow-up. Principal toxicities included neutropenic sepsis and subclinical doxorubicin cardiotoxicity.
Conclusions:
- Aggressive chemotherapy, particularly ProMACE-CytaBOM, is a feasible and effective treatment for phenotypically monoclonal PTLD refractory to immunosuppression reduction in cardiac transplant recipients.
- The ProMACE-CytaBOM regimen is suitable for cardiac recipients, minimizing doxorubicin exposure and avoiding concurrent immunosuppressives, leading to durable remissions.