Ann Liver Transplant.  2021 May;1(1):95-99. 10.52604/alt.21.0014.

Successful treatment of the Epstein-Barr virus-negative post-transplant lymphoproliferative disorder, Ann Anbor stage IVB, using R-CHOP: a case report

• Lee MR
• Yang JD
• Yu HC

• KMID: 2560857
• DOI: http://doi.org/10.52604/alt.21.0014

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is recognized as one of the most fatal complication of solid organ transplantation and allogenic hematopoietic stem cell transplantation. Standard treatment of PTLD is reduction in immunosuppression (RIS) and “R-CHOP” (rituximab-cyclophophamide, doxorubin, vincristine, prednisolone) regimen. We report successful chemotherapy treatment using R-CHOP without RIS in a patient with Ann Arbor stage IV PTLD and the high risk group based on the international prognostic index score. The patient was 69-year-old man who had been receiving immunosuppressive therapy with tacrolimus since undergoing a living liver transplant 7 years prior. He presented that he had experienced chronic dry cough for 3 months and uncontrolled hiccup 1 week prior to the current admission. Abdominal pelvic computed tomography (CT) and Positron emission tomography (PET)-CT revealed liver, small bowel, bone (C7 and T1) and extra-nodal (both diaphragm). Ultrasonography-guided biopsy was performed, and he was histologically diagnosed with EBV-negative diffuse large B-cell lymphoma (DLBCL). Six-cycles of chemotherapy with a R-CHOP regimen without RIS were administered, and 6 months later, CT and PET-CT performed thereafter indicated complete remission. In this case, even if therapeutic efficacy is predicted to be low because of an Ann Arbor stage IVB and the high risk group based on the International prognostic index score, the patient with an EBV-negative PTLD achieved complete remission using 6-cycles R-CHOP regimen without RIS.

Keyword

Post-transplant lymphoproliferative disorder; Liver transplantation; Rituximab