Abstract
Posttransplant lymphoproliferative disease (PTLD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. We describe here the case of a boy with history of induction failure of a T-cell acute lymphoblastic leukemia, who presented a life-threatening situation of nonengraftment and rituximab-refractory PTLD after the first hematopoietic stem cell transplantation. We decided to use an unusual strategy of combining a nonmyeloablative conditioning (fludarabine and cyclophosphamide) with a calcineurin inhibitor-free GvHD prophylaxis (sirolimus and mycophenolate mofetil). This strategy had permitted the control of an Epstein-Barr virus PLTD in umbilical cord blood transplantation without further reactivation.
MeSH terms
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Antibodies, Monoclonal, Murine-Derived / pharmacology*
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Antineoplastic Agents / pharmacology
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Calcineurin*
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Child
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Combined Modality Therapy
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Drug Resistance, Neoplasm
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Graft vs Host Disease / prevention & control*
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Hematopoietic Stem Cell Transplantation / adverse effects*
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Humans
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Immunosuppressive Agents / therapeutic use
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Lymphoproliferative Disorders / etiology
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Lymphoproliferative Disorders / therapy*
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Male
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Mycophenolic Acid / analogs & derivatives*
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Mycophenolic Acid / therapeutic use
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Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / complications*
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Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / therapy
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Prognosis
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Rituximab
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Sirolimus / therapeutic use*
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Transplantation Conditioning
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Transplantation, Homologous
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Vidarabine / analogs & derivatives
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Vidarabine / therapeutic use
Substances
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Antibodies, Monoclonal, Murine-Derived
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Antineoplastic Agents
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Immunosuppressive Agents
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Rituximab
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Calcineurin
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Vidarabine
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Mycophenolic Acid
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fludarabine
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Sirolimus