One of the unfortunate consequences of solid organ or bone marrow transplantation is the occurrence of a post-transplant lymphoproliferative disorder (PTLD). These tumors run a variable course; some regress with a reduction in the doses of immunosuppressive agents, whereas others progress to an aggressive NHL and require systemic therapy. Chemotherapy has been relatively unsuccessful against such tumors, and the outcome is generally fatal.
Several recent reports have suggested that rituximab(Drug information on rituximab) may play a major role in the management of these disorders. Milpied et al (abstract #2803) retrospectively analyzed 32 patients who developed PTLD following transplantation of a variety of solid organs or bone marrow. Rituximab was used as initial therapy in 30 patients and as salvage therapy in the remaining 2. The antibody achieved CRs in 30 patients (94%) and PRs in the remaining 2 cases. At a median follow-up of 10 months, 22 patients were alive and 18 remained in remission. Hopefully, a national collaborative trial currently in progress in the United States will confirm these encouraging findings.
Bruce D. Cheson, MD