TY - JOUR
T1 - Post-transplant lymphoproliferative disorder in children
T2 - Recent outcomes and response to dual rituximab/low-dose chemotherapy combination
AU - Gupta, Sushil
AU - Fricker, Frederick J.
AU - González-Peralta, Regino P.
AU - Slayton, William B.
AU - Schuler, Pamela M.
AU - Dharnidharka, Vikas R.
PY - 2010/11
Y1 - 2010/11
N2 - Gupta S, Fricker FJ, González-Peralta RP, Slayton WB, Schuler PM, Dharnidharka VR. Post-transplant lymphoproliferative disorder in children: Recent outcomes and response to dual rituximab/low-dose chemotherapy combination. Pediatr Transplantation 2010: 14:896-902. 2010 John Wiley & Sons A/S. Abstract: PTLD is a major complication after transplantation. Treatment options for PTLD are not standardized, usually sequential, starting with reduction in immunosuppression. Recently, we have used a dual combination of rituximab and reduced dose chemotherapy (R/C) directly after failed RI. We retrospectively identified 30 pediatric PTLD cases across four organ systems at our center from 1995 to 2008. We assessed recent outcomes of PTLD in children, comparing the responses to different regimens. Two-yr failure-free survival was best in renal and heart recipients (80-88%), followed by liver (57%) and lung (0%). Of note, two patients were Epstein-Barr peripheral blood viral load low positive but tumor EBER negative. Three patients had no detectable viral load but were EBER positive. The R/C regimen (n = 8) had the highest CR rate (100%), low recurrence (12%) and lowest mortality (12%). Interferon (n = 4) had 75% CR, 33% recurrence and 25% mortality. Rituximab/prednisone (n = 5) had 80% CR, 50% recurrence and 20% mortality. Other chemotherapy (n = 7, including all 4 T-cell PTLDs) had 57% CR, 0% recurrence and 14% mortality. Direct dual R/C combination therapy after failed RI is effective and offers another treatment option for B-cell PTLD.
AB - Gupta S, Fricker FJ, González-Peralta RP, Slayton WB, Schuler PM, Dharnidharka VR. Post-transplant lymphoproliferative disorder in children: Recent outcomes and response to dual rituximab/low-dose chemotherapy combination. Pediatr Transplantation 2010: 14:896-902. 2010 John Wiley & Sons A/S. Abstract: PTLD is a major complication after transplantation. Treatment options for PTLD are not standardized, usually sequential, starting with reduction in immunosuppression. Recently, we have used a dual combination of rituximab and reduced dose chemotherapy (R/C) directly after failed RI. We retrospectively identified 30 pediatric PTLD cases across four organ systems at our center from 1995 to 2008. We assessed recent outcomes of PTLD in children, comparing the responses to different regimens. Two-yr failure-free survival was best in renal and heart recipients (80-88%), followed by liver (57%) and lung (0%). Of note, two patients were Epstein-Barr peripheral blood viral load low positive but tumor EBER negative. Three patients had no detectable viral load but were EBER positive. The R/C regimen (n = 8) had the highest CR rate (100%), low recurrence (12%) and lowest mortality (12%). Interferon (n = 4) had 75% CR, 33% recurrence and 25% mortality. Rituximab/prednisone (n = 5) had 80% CR, 50% recurrence and 20% mortality. Other chemotherapy (n = 7, including all 4 T-cell PTLDs) had 57% CR, 0% recurrence and 14% mortality. Direct dual R/C combination therapy after failed RI is effective and offers another treatment option for B-cell PTLD.
KW - Epstein-Barr virus
KW - PTLD
KW - children
KW - outcome
KW - rituximab
KW - solid organ
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=78349235420&partnerID=8YFLogxK
U2 - 10.1111/j.1399-3046.2010.01370.x
DO - 10.1111/j.1399-3046.2010.01370.x
M3 - Article
C2 - 20642490
AN - SCOPUS:78349235420
SN - 1397-3142
VL - 14
SP - 896
EP - 902
JO - Pediatric transplantation
JF - Pediatric transplantation
IS - 7
ER -