Successful treatment of a child with late-onset T-cell post-transplant lymphoproliferative disorder/lymphoma

Pediatr Blood Cancer. 2008 Mar;50(3):667-70. doi: 10.1002/pbc.21171.

Abstract

We report a novel regimen for refractory post-transplant T-cell lymphoma (PTL). Our patient presented with non-Epstein-Barr virus (EBV) related, T-cell post-transplant lymphoproliferative disease (PTLD) 3.5 years after liver transplantation. Initially diagnosed as polyclonal PTLD, the disease progressed to a monoclonal, T-cell PTL that was refractory to several chemotherapy regimens but responded to a regimen consisting of fludarabine, cyclophosphamide, cytarabine, and alemtuzumab. Consolidation therapy included high-dose chemotherapy, autologous hematopoietic stem cell rescue, and radiation therapy. She remains in remission 2.5 years later. T-cell PTL is a rare disease with a poor prognosis; this regimen provides a novel, potentially curative approach for its treatment.

Publication types

  • Case Reports

MeSH terms

  • Alemtuzumab
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biliary Atresia / surgery
  • Carboplatin / administration & dosage
  • Carmustine / administration & dosage
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Disease Progression
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Female
  • Granulocyte Colony-Stimulating Factor / administration & dosage
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Ifosfamide / administration & dosage
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Liver Transplantation*
  • Lymphoma, T-Cell, Peripheral / drug therapy
  • Lymphoma, T-Cell, Peripheral / etiology
  • Lymphoma, T-Cell, Peripheral / radiotherapy
  • Lymphoma, T-Cell, Peripheral / surgery
  • Lymphoma, T-Cell, Peripheral / therapy*
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / therapy*
  • Melphalan / administration & dosage
  • Mesna / administration & dosage
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / radiotherapy
  • Postoperative Complications / surgery
  • Postoperative Complications / therapy*
  • Prednisone / administration & dosage
  • Radiotherapy, Adjuvant
  • Transplantation, Autologous
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives
  • Vincristine / administration & dosage

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neoplasm
  • Immunosuppressive Agents
  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Alemtuzumab
  • Vincristine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Carboplatin
  • Vidarabine
  • Mesna
  • fludarabine
  • Melphalan
  • Carmustine
  • Ifosfamide
  • Prednisone

Supplementary concepts

  • BEAM regimen
  • EPOCH protocol
  • ICE protocol 5