Intraventricular rituximab and systemic chemotherapy for treatment of central nervous system post-transplant lymphoproliferative disorder after kidney transplantation. Pediatr Transplant 2012 Sep;16(6):E201-9
Date
06/01/2012Pubmed ID
22646132DOI
10.1111/j.1399-3046.2012.01699.xScopus ID
2-s2.0-84864609976 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
PTLD of the CNS is a rare complication of solid organ transplantation, and there are only case reports/series available in the literature. Current literature suggests that CNS PTLD carries a worse prognosis than PTLD outside the CNS, and most are of B-cell lineage, predominantly monomorphic, and are associated with EBV infection. Because this disorder is so rare, there is no standard chemotherapy for pediatric patients with CNS PTLD and reported therapies for EBV-associated CNS PTLD are heterogeneous with mixed results. Since outcomes of CNS PTLD are historically poor, we attempted to develop a novel therapeutic treatment regimen. Based on a review of the literature and with the help of a multidisciplinary team, we created a regimen of chemotherapy that included dexamethasone and high-dose methotrexate in addition to intravenous and intraventricular Rituximab in two pediatric patients. The intraventricular chemotherapy succeeded in shrinking the tumor in both of our patients; however, as shown in the second case, the clinical outcome depends on the location of the tumor. Systemic and intraventricular therapies hold promise in the management of EBV-associated CNS PTLD; however the rarity of this entity prevents the development of well-designed studies necessary for the establishment of an evidence-based treatment standard.
Author List
Twombley K, Pokala H, Ardura MI, Harker-Murray P, Johnson-Welch SF, Weinberg A, Seikaly MAuthor
Paul D. Harker-Murray MD, PhD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Antibodies, Monoclonal, Murine-Derived
B-Lymphocytes
Central Nervous System Diseases
Dexamethasone
Drug Therapy, Combination
Epstein-Barr Virus Infections
Fatal Outcome
Herpesvirus 4, Human
Humans
Immunologic Factors
Infusions, Intraventricular
Kidney Transplantation
Lymphoproliferative Disorders
Magnetic Resonance Imaging
Male
Methotrexate
Postoperative Complications
Prognosis
Rituximab
Seizures
Treatment Outcome
