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Rossignol J, Terriou L, Robu D, Willekens C, Hivert B, Pascal L, Guieze R, Trappe R, Baillet C, Huglo D, Morschhauser F. Radioimmunotherapy ((90) Y-Ibritumomab Tiuxetan) for Posttransplant Lymphoproliferative Disorders After Prior Exposure to Rituximab. Am J Transplant 2015; 15:1976-81. [PMID: 25868706 DOI: 10.1111/ajt.13244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/18/2015] [Accepted: 01/25/2015] [Indexed: 01/25/2023]
Abstract
Posttransplantation lymphoproliferative disorders (PTLDs) are life-threatening complications after solid organ and hematopoietic stem cell transplantation. Only half of CD20-positive PTLDs respond to rituximab monotherapy, and outcomes remain poor for patients with relapsed/refractory disease, especially those who do not qualify for an anthracycline containing regimen due to frailty or comorbidities. Radioimmunotherapy (RIT) might be an option in this particular setting. We report a panel of eight patients with rituximab refractory/relapsed CD20-positive PTLDs including three ineligible for subsequent CHOP-like chemotherapy who received (90) Y-Ibritumomab tiuxetan as a single agent (n = 7) or combined to chemotherapy (n = 1). Five out of eight patients were kidney transplant recipients, while 2/8 had a liver transplant and 1/8 had a heart transplant. Patients received a median of two previous therapies. Overall response rate was 62.5%. Importantly, all responders achieved complete response. At a median follow-up of 37 months [5; 84], complete response was ongoing in four patients. Toxicity was predominantly hematological and easily manageable. No graft rejection was noticed concomitantly or following RIT administration despite immunosuppression reduction after diagnosis of PTLDs. This report emphasizes the potential efficiency of salvage RIT for early rituximab refractory PTLDs without any unexpected toxicity.
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Affiliation(s)
- J Rossignol
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - L Terriou
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - D Robu
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - C Willekens
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - B Hivert
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - L Pascal
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - R Guieze
- Service des Maladies du Sang, CHRU de Lille, Lille, France
| | - R Trappe
- Division of Hematology and Oncology, Department of Medicine, Ev. Diakonie-Krankenhaus, Bremen, Germany
| | - C Baillet
- Service de médecine nucléaire, CHRU de Lille, Lille, France
| | - D Huglo
- Service de médecine nucléaire, CHRU de Lille, Lille, France
| | - F Morschhauser
- Service des Maladies du Sang, CHRU de Lille, Lille, France
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Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, Marcus R, Parameshwar J, Ramsay A, Newstead C. Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol 2010; 149:693-705. [PMID: 20408848 DOI: 10.1111/j.1365-2141.2010.08160.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Transplantation Society (BTS) has reviewed the available literature and made recommendations for the diagnosis and management of post-transplant lymphoproliferative disorder in adult recipients of solid organ transplants. This review details the therapeutic options recommended including reduction in immunosuppression (RIS), transplant organ resection, radiotherapy and chemotherapy. Effective therapy should be instituted before progressive disease results in declining performance status and multi-organ dysfunction. The goal of treatment should be a durable complete remission with retention of transplanted organ function with minimal toxicity.
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Affiliation(s)
- Anne Parker
- The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
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Vitolo U, Barosi G, Fanti S, Gianni AM, Martelli M, Petrini M, Zinzani PL, Tura S. Consensus conference on the use of 90-yttrium-ibritumomab tiuxetan therapy in clinical practice. A project of the Italian society of hematology. Am J Hematol 2010; 85:147-55. [PMID: 20095035 DOI: 10.1002/ajh.21602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto Vitolo
- Department of Oncology and Hematology, Hematology 2, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.
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