Successful Multi-Modality Therapy of Monoclonal Lymphoproliferative Disease in a Lung Transplant Recipient

Abstract

The incidence of posttransplant lymphoproliterative disease (PTLD) in lung transplant recipients is about 8 %. Prognosis of patients presenting with the monoclonal type is poor with a mortality rate up to 80 %. We report on a patient who was successfully treated by a combined therapy regimen. Double lung transplantation was performed in a 21-yr-old dwarf patient because of multiple lung cysts. Two months after operation mediastinal masses were diagnosed as monocional PTLD. Radiation therapy and reduction of immunosuppression failed; the PTLD showed rapid progression with appearance of additional multiple pulmonary tumors. Maasive acute rejection (A4) was treated successfully by high-dose methylprednisolone for 4 days. On the 4th day, the first course of chemotherapy (CHOP) was started (Feb 28, 1992). High-dose aciclovir and ganciclovir were administered ex juvantlbus and prophylactically at the same time although there were no signs of infection. As the tumor showed progression 14 days after the first chemotherapy and needle biopsy was not conclusive, the second course of chemotherapy was combined with iv Infusions of monoclonal anti-CD24 antibodies.