P0096 Pp Post‐transplant Lymphoproliferative Disease in Pediatric Liver Transplant Recipients Treated With Anti‐cd20 Monoclonal Antibody: a Long‐term Outcome Study
Year: 2004
Type: conference-abstract
Abstract: Introduction: Post-transplant lymphoproliferative disorders (PTLD) are a well-known complication following organ transplantation. Pediatric liver transplant (LTx) patients have a greater risk, since many of them are sero-negative for Epstein-Barr Virus (EBV) at the time of LTx. Several studies have confirmed the positive correlation of EBV viral load and PTLD. The standard of care in managing PTLD is reduction or withdrawal of immunosuppression; however, this is associated with a high incidence of mortality due to graft rejection. Recently, rituximab, a chimeric humanized anti-CD20 monoclonal antibody (MoAb) has opened new treatment possibilities. Aim: Although much experience has been accumulated on short-term effects on EBV-associated PTLD, we sought to determine the long-term treatment outcomes with anti-CD20 MoAb and baseline immunosuppression. Methods: A retrospective review of 52 patients who underwent liver transplantation at Texas Children’s Hospital between 1998 and 2003 was performed. Diagnosis was made by presence of bulky lesions or progressive disseminated disease along with proliferation of B-cells expressing the CD20 antigen. Results: Five post-LTx children (median age 73 months; range: 31–105 months) were diagnosed with EBV-associated PTLD. At the time of diagnosis, the mean EBV viral load measured by PCR of peripheral blood was 14,076 copies/mcg of DNA. Patients were treated with 4 weekly intravenous doses of anti-CD20 MoAb at 375 mg/m2. Immunosuppression was modified to maintain a tacrolimus or cyclosporine trough concentration between 3–6 ng/ml or 50–75 ng/ml, respectively. Clinical remission of PTLD was achieved 4 weeks after completing therapy with an absence of B-cells and a decrease in EBV viral load to a mean of 73 copies/mcg of DNA. Two patients reached undetectable levels of EBV titer 4 weeks after completion of anti-CD20 MoAb, and of these, 1 patient maintained a negative EBV titer. Five months after therapy, B-cells returned to a level of >1% in all patients, and we noted that EBV titers also increased to a mean of 1,458 copies/mcg (range: 0–4246 copies/mcg) of DNA. All patients are alive and disease free after a median follow-up of 23 months (range: 10–32 months). No patient has experienced recurrence of disease, even with the resurgence of EBV viremia. Conclusion: Anti-CD20 MoAb along with a reduction in immunosuppression is effective in the long-term management of PTLD. However, further follow-up is necessary with the resurgence of EBV viremia and the potential for recurrence of PTLD many years after this therapy.
Institutions: Texas Children's Hospital, Baylor College of Medicine
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4390569013