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Rituximab and rapamycin for posttransplant lymphoproliferative disease treatment: report of three cases

2002; Elsevier BV; Volume: 34; Issue: 7 Linguagem: Inglês

10.1016/s0041-1345(02)03511-x

1873-2623

Valter Duro Garcı́a, José Luiz Bonamigo Filho, Jorge Neumann, Laura Fogliatto, Alexander Gaiger, Clotilde Druck Garcia, Evelynne Letícia S. F. C. de Barros, Elizete Keitel, A.E Bittar, Adriana Santos, Sérgio Roithmann,

Renal Transplantation Outcomes and Treatments

Posttransplant lymphoproliferative disorder (PTLD) remains one of the most important complications of intensive immunosuppressive therapy. A 65-year-old Caucasian woman received a primary en bloc kidney transplant from a deceased 2-year-old donor. After antithymocyte globulin induction she was treated with a maintenance regimen including cyclosporine and mycophenylate mofetil (MMF). She had a history of recurrent dermatomyositis, suggesting a flawed immune system. After a benign course for 9 months and after an increase in MMF from 2 to 3 g daily, she presented with pneumonia owing to Candida albicans, which was responsive to antibiotics, as was the PTLD. Persistent fever led to a diagnosis of PTLD. The immunosuppressive regimen was converted to sirolimus (SRL) and rituximab, with over 90% necrosis of the neoplasm at 1 month. However, owing to concern at exploration, the allografts were extirpated. This case documented the benefit of the rituximab–SRL combination to treat PTLD while maintaining dermatomyositis in remission.