Outcome of Rapamycin Therapy for PostTransplant- Lymphoproliferative Disorder after Kidney Transplantation: Case Series
Background: Post-transplant lymphoproliferative disorders (PTLD) are a complication of chronic immunosuppressive therapy in solid organ transplantation with a high mortality rate. Alternative treatments such as rapamycin have been explored.
Methods: A detailed retrospective analysis was performed according to data collected from 13 patients with PTLD. At the time of PTLD diagnosis, immunosuppressive therapy was decreased and rapamycin administered. Overall survival, disease-free survival of patients and graft survival were determined.
Results: Among 590 kidney transplant recipients, 13 adult patients with PTLD were included in this study. The mean age of the patients was 42.15 (range: 25-58) years at the time of PTLD diagnosis, and 9 patients were male. Histology was distributed in 9 diffuse large B cell, 1 Malt lymphoma, 1 Burkitt lymphoma, 2 Hodgkin-like PTLD. The response rate to rapamycin alone was 30.8%. The mean overall survival period was 23.38 months and 11 patients are still alive. In total, 10 patients (76.9%) achieved a complete remission with functioning graft in 11 (84.6%) patients.
Conclusion: Despite the retrospective focus and limited number of patients, this study provides promising results regarding the effectiveness of stopping calcineurin inhibitors and switching to rapamycin for patients with PTLD.
Einollahi B, Rostami Z, Nourbala MH, et al. Incidence of malignancy after living kidney transplantation: a multicenter study from iran. Journal of Cancer. 2012;3:246-56. Epub 2012/06/20.
Kalinova L, Indrakova J, Bachleda P. Post-transplant lymphoproliferative disorder. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009; 153(4):251-7.
Blaes AH, Peterson BA, Bartlett N, et al. Rituximab therapy is effective for posttransplant lymphoproliferative disorders after solid organ transplantation. Cancer. 2005; 104(8):1661-7.
Manuelli M, De Luca L, Iaria G, et al., editors. Conversion to rapamycin immunosuppression for malignancy after kidney transplantation. Transplantation proceedings; 2010: Elsevier.
Tsai DE, Hardy CL, Tomaszewski JE, et al. Reduction in Immunosuppression As Initial Therapy for Posttransplant Lymphoproliferative Disorder: Analysis of Prognostic Variables and Long-Term Follow-Up of 42 Adult Patients1. Transplantation. 2001;71(8):1076-88.
Ghobrial IM, Habermann TM, Maurer MJ, et al. Prognostic analysis for survival in adult solid organ transplant recipients with post-transplantation lymphoproliferative disorders. Journal of clinical oncology. 2005;23(30):7574-82.
LaCasce AS. Post-transplant lymphoproliferative disorders. The oncologist. 2006;11(6):674-80.
Nepomuceno RR, Balatoni CE, Natkunam Y, et al. Rapamycin inhibits the interleukin 10 signal transduction pathway and the growth of Epstein Barr virus B-cell lymphomas. Cancer research. 2003;63(15):4472-80.
Teachey DT, Grupp SA, Brown VI. Mammalian target of rapamycin inhibitors and their potential role in therapy in leukaemia and other haematological malignancies. British journal of haematology. 2009;145(5):569-80.
Saunders RN, Metcalfe MS, Nicholson ML. Rapamycin in transplantation: a review of the evidence. Kidney international. 2001;59(1):3-16.
Dominguez J, Mahalati K, Kiberd B, et al. Conversion to Rapamycin Immunosuppression in Renal Transplant Recipients: Report of An Initial Experience1. Transplantation. 2000;70(8):1244-7.
Kahan BD, Camardo JS. Rapamycin: Clinical Results and Future Opportunities1. Transplantation. 2001;72(7):1181-93.
Oertel SH, Verschuuren E, Reinke P, et al. Effect of Anti‐CD 20 Antibody Rituximab in Patients with Post‐Transplant Lymphoproliferative Disorder (PTLD). American journal of transplantation. 2005;5(12):2901-6.
Kahan BD, Yakupoglu YK, Schoenberg L, et al. Low incidence of malignancy among sirolimus/cyclosporine-treated renal transplant recipients. Transplantation. 2005;80(6):749-58.
Garber K. Rapamycin may prevent post-transplant lymphoma. Journal of the National Cancer Institute. 2001;93(20):1519-.
Boratyoska M, Smolska D. Inhibition of mTOR by sirolimus induces remission of post‐transplant lymphoproliferative disorders. Transplant International. 2008;21(6):605-8.
Cullis B, D’Souza R, McCullagh P, et al. Sirolimus-induced remission of posttransplantation lymphoproliferative disorder. American Journal of Kidney Diseases. 2006; 47(5):e67-e72.
Pascual J. Post-transplant lymphoproliferative disorder—the potential of proliferation signal inhibitors. Nephrology Dialysis Transplantation. 2007;22(suppl 1):i27-i35.
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