scholarly journals CD20 expression predicts survival in paediatric post-transplant lymphoproliferative disease (PTLD) following solid organ transplantation

2011 ◽  
Vol 152 (6) ◽  
pp. 733-742 ◽  
Author(s):  
Manuela A. Orjuela ◽  
Bachir Alobeid ◽  
Xinhua Liu ◽  
Aisha L. Siebert ◽  
Emily R. Kott ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Lymphoproliferative Disease ◽  
Solid Organ ◽  
Post Transplant ◽  
Cd20 Expression

Expression of CD20 but Not EBV Is Associated with Significantly Improved Overall (OS) and Event Free Survival (EFS) in Children with Post Transplant Lymphoproliferative Disease (PTLD) Following Solid Organ Transplantation (SOT).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1787-1787
Author(s):  
Manuela A. Orjuela ◽  
Bachir Alobeid ◽  
Xinhua Liu ◽  
Aisha L. Siebert ◽  
Emily R. Kott ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Prognostic Significance ◽  
Solid Organ Transplantation ◽  
Young Patients ◽  
Lymphoproliferative Disease ◽  
Wilcoxon Test ◽  
Time Interval ◽  
Solid Organ ◽  
Post Transplant ◽  
Significant Difference

Abstract The risk of developing post transplant lymphoproliferative disease (PTLD) following solid organ transplantation (SOT) in children is in large part dependent on the specific organ transplanted and the degree of immune suppression post SOT (Webber et al Lancet 2006; Dharnidharka et al Transplantation 2001; Newell et al Transplantation 1996). However, the importance of expression of CD20 and/or Epstein-Barr virus (EBV) as prognostic factors for development and survival of pediatric PTLD after SOT in young patients are poorly understood. We previously demonstrated the safety and efficacy of cyclophosphamide, prednisone and rituximab (CPR) in CD20+ PTLD (Orjuela/Cairo, CCR 2005). We now report on our experience in children, adolescents and young adults with PTLD following SOT treated at a single institution from 1990–2008 and on the prognostic significance of expression of CD20 and EBV in this population. 45 SOT pts (28 heart, 11 liver, 6 kidney) were diagnosed with PTLD (53.3 % female) at a mean onset of 45±43 months (mo) post primary SOT (4–153). Three patients had multiple SOT. Age at diagnosis of PTLD ranged from14 to 287 mo with mean 118 (SD=77) mo. EBV and CD20 status were evaluated in all evaluable tumor sites. CD20 status was categorized as positive when all tumor sites expressed CD20 (by IHC) and negative when only some or no tumor sites expressed CD20. EBV status was categorized as positive when any tumor sites were EBV positive (by ISH), and negative when no tumor sites were EBV positive. Of 40 evaluable tumors (11 monomorphic, 19 polymorphic, 5 early lesions, 2 T-cell lymphomas, and 3 rarer types (2 HD, 1 multiple myeloma like), 32 (80%) had detectable EBV, while 28 (70%) were classified as CD20 positive. EBV expression was unrelated to age at SOT. Those patients whose PTLD expressed CD20 and/or EBV had shorter time interval between last SOT and the onset of PTLD (CD20 positive vs negative (mean±SD): 28±31 mo vs 64±44 mo, p<0.01, EBV positive vs negative: 29±24 vs 77±59 mos, p<0.02, Wilcoxon test). After controlling for the age at last SOT in the regression model for the time interval between last SOT and PTLD, expression of either CD20 or EBV was significantly associated with the shorter length of the interval. All patients had immunosuppression reduced, followed by chemo-and immunotherapy as needed. Patients with CD20 positive PTLD had a higher 5-year overall and PTLD related EFS than those patients whose PTLD was CD20 negative (92 vs 56%, p=0.02; 84 vs 29%, p<0.001, Chi-square test). The survival curve for EFS differed by CD20 status, log rank test, p<0.01 (Figure one). Organ transplant type and morphology subtype were unrelated to OS or EFS. There was no significant difference in OS or EFS based on EBV expression. In summary, expression of CD20 and/or EBV in young patients with PTLD post SOT are both important predictors of the length of time that elapses between SOT and development of PTLD. CD20 positive PTLD is associated with significantly improved 5-year OS and EFS for PTLD in young SOT patients. Patients with CD20 negative PTLD appear to have lower 5-year survival and EFS suggesting a need for alternative treatment strategies. Figure Figure

scholarly journals Epstein-Barr Virus–Positive Posttransplant Lymphoproliferative Disease After Solid Organ Transplantation

2016 ◽  
Vol 2 (1) ◽  
pp. e48 ◽  
Author(s):  
Marieke L. Nijland ◽  
Marie José Kersten ◽  
Steven T. Pals ◽  
Frederike J. Bemelman ◽  
Ineke J.M. ten Berge
Keyword(s):  
Organ Transplantation ◽  
Epstein Barr Virus ◽  
Solid Organ Transplantation ◽  
Lymphoproliferative Disease ◽  
Solid Organ ◽  
Barr Virus ◽  
Posttransplant Lymphoproliferative Disease ◽  
Epstein Barr

Cytotoxic T-lymphocyte therapy for post-transplant lymphoproliferative disorder after solid organ transplantation in children

2018 ◽  
Vol 22 (2) ◽  
pp. e13133 ◽  
Author(s):  
Fang Kuan Chiou ◽  
Sue V. Beath ◽  
Gwen M. Wilkie ◽  
Mark A. Vickers ◽  
Bruce Morland ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
T Lymphocyte ◽  
Lymphoproliferative Disorder ◽  
Cytotoxic T Lymphocyte ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Post Transplant

Solid Organ Transplantation in HIV-Infected Individuals

2017 ◽  
Author(s):  
Eurides Lopes ◽  
Jennifer Husson
Keyword(s):  
Organ Transplantation ◽  
Opportunistic Infections ◽  
Solid Organ Transplantation ◽  
Team Approach ◽  
Solid Organ ◽  
Hiv Disease ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Liver And Kidney ◽  
Infectious Disease Specialists

End-organ disease has become a major cause of morbidity and mortality in HIV-infected patients due to increased life expectancy, increasing the demand for organ transplantation in these patients. The care of HIV-infected transplant recipients warrants a multidisciplinary team approach, including the transplant team, pharmacists, infectious disease specialists, nurses, and patients and their families. The immunosuppression of HIV-infected recipients post-transplant does not appear to further advance HIV disease. The post-transplant risk for HIV-infected recipients of opportunistic infections does not appear to be increased by immunosuppression. However, the overall rate of infections is high, and it is even higher in hepatitis C virus (HCV) co-infected transplant recipients. HIV/HCV co-infected recipients have worse outcomes compared to both liver and kidney HIV-infected recipients.

Bortezomib and Rituximab in the Treatment of Post-Transplant Lymphoproliferative Disorders

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4947-4947 ◽  
Author(s):  
Anne Hudson Blaes ◽  
Dale E. Hammerschmidt ◽  
Bruce A. Peterson
Keyword(s):  
Clinical Trial ◽  
Overall Survival ◽  
Organ Transplantation ◽  
Progressive Disease ◽  
Conflicts Of Interest ◽  
Bone Marrow Involvement ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Poor Overall Survival ◽  
Post Transplant

Abstract Abstract 4947 Background: Post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation is an aggressive disease that is difficult to treat, and has a high mortality rate and poor overall survival. While rituximab has become an important part of the treatment for this disorder, additional therapies are needed. Methods: Adults > 18 years with a diagnosis of CD 20-positive PTLD following solid organ transplantation were invited to participate in a clinical trial between 2009–2011 if they had adequate kidney and liver function. No patient had central nervous system disease or bone marrow involvement. Patients received four weekly doses of rituximab 375 mg/m2 and bortezomib 1.4 mg/m2 days 1, 8, 15, 22. One month following the completion of this induction therapy, patients who achieved a partial remission (PR) or stable disease (SD) (as assessed by positron emission tomography [PET]) received additional bortezomib 1.4 mg/m2 on days 1, 4, 8, 11, repeated every 3 weeks for 4 additional cycles. Patients who had achieved a complete remission (CR) were given maintenance rituximab and bortezomib (four weekly doses 375 mg/m2 and 1.4 mg/m2, respectively) on an every-six-month basis for a total of two years. If at any time a patient had progressive disease, they were removed from the clinical trial. Immunosuppression was decreased at the time of diagnosis and treatment at the discretion of the primary treating transplant physician. Results: Three patients (ages 29, 48 and 72 y) developed PTLD following kidney (n=2) or bilateral lung/kidney transplantation (n=1), and were enrolled at the University of Minnesota. All three patients' tumors were histologically diffuse large-cell lymphomas of B-cell lineage. 2/3 were positive for Epstein-Barr virus by EBER. Time from transplantation to the development of PTLD was 5, 15, and 17 years. One patient achieved a PR after the initial induction chemotherapy and went on to achieve a CR after additional bortezomib administration. The patient remains in CR after 18 months. One patient had progressive disease within the first month of treatment and was removed from the clinical trial. This patient had a previous diagnosis of PTLD six years earlier and had received prior rituximab; she remains alive more than six months after diagnosis and the administration of systemic chemotherapy with an anthracycline based regimen. The final patient achieved a CR after induction with bortezomib and rituximab alone and remains disease free at more than 7 months after diagnosis. 1/3 patients developed grade 3 neuropathy. No other significant toxicities were seen that were attributable to the drug administration. Conclusion: PTLD is a difficult disease to treat. While the data from this study reflect only three patients, two of the three patients treated achieved CR after receiving rituximab plus bortezomib. The addition of a proteosome inhibitor such as bortezomib to rituximab may lead to increased durable remission rates and improved overall survival. Additional studies are warranted. Disclosures: No relevant conflicts of interest to declare.

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