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Clin Lymphoma Myeloma Leuk. 2013 Dec;13(6):716-20. doi: 10.1016/j.clml.2013.07.006. Epub 2013 Sep 11.

Chemoimmunotherapy and withdrawal of immunosuppression for monomorphic posttransplant lymphoproliferative disorders.

Author information

1
Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Electronic address: nikolai.podoltsev@yale.edu.

Abstract

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 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 multi-institutional setting.

KEYWORDS:

Graft loss; Organ rejection; Rituximab; Solid organ transplantation; Treatment-related mortality

PMID:
24035715
PMCID:
PMC3846604
DOI:
10.1016/j.clml.2013.07.006
[Indexed for MEDLINE]
Free PMC Article
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