Posttransplantation lymphoproliferative disorders treated with cyclophosphamide-doxorubicin-vincristine-prednisone chemotherapy

T. J. Garrett, A. Chadburn, M. L. Barr, R. E. Drusin, J. M. Chen, L. L. Schulman, C. R. Smith, D. S. Reison, E. A. Rose, R. E. Michler, Robert E. Michler

Research output: Contribution to journalArticle

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Abstract

Background. Posttransplantation lymphoproliferative disorders after solid organ transplantation are a serious complication occurring in 1-10% of patients. Different therapies have been used, but the optimal treatment is unknown. There is relatively little information in the literature on the experience with cytotoxic chemotherapy. Methods. The disease stage of patients with biopsy-documented posttransplantation lymphoproliferative was determined with standard methods to establish the extent of the disease. Patients in whom the disease failed to regress after initial management, which included reduction in immunosuppression, were treated with a combination chemotherapy regimen consisting of six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Response to therapy was determined by following previously defined sites of disease with appropriate tests. Patients were maintained on a reduced dose of immunosuppressants. Results. In the four patients studied, lymphoproliferative disorders developed after heart (three cases) or lung (one case) transplantation, which did not regress after immunosuppression was reduced. All four experienced a complete remission with CHOP chemotherapy, which continued at 3, 13+, 20 and 30+ months after completion of treatment. One patient died of sepsis after completing therapy at a point when his leukocyte count was normal, and no evidence of posttransplantation lymphoproliferative disorder was found at autopsy. A second patient died of liver failure with no clinical evidence of lymphoproliferative disorder. Conclusion. Although this is a small series, it demonstrates that patients with posttransplantation lymphoproliferative disorders may respond to cytotoxic chemotherapy. The duration of response is undetermined.

Original languageEnglish (US)
Pages (from-to)2782-2785
Number of pages4
JournalCancer
Volume72
Issue number9
DOIs
StatePublished - 1993
Externally publishedYes

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Lymphoproliferative Disorders
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Drug Therapy
Immunosuppression
Therapeutics
Liver Failure
Organ Transplantation
Immunosuppressive Agents
Combination Drug Therapy
Leukocyte Count
Autopsy
Sepsis
Transplantation
Biopsy
Lung

Keywords

  • cardiac transplantation
  • immunosuppressive therapy
  • lung transplantation
  • non-Hodgkin lymphoma
  • posttransplantation lymphoproliferative disorders

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Posttransplantation lymphoproliferative disorders treated with cyclophosphamide-doxorubicin-vincristine-prednisone chemotherapy. / Garrett, T. J.; Chadburn, A.; Barr, M. L.; Drusin, R. E.; Chen, J. M.; Schulman, L. L.; Smith, C. R.; Reison, D. S.; Rose, E. A.; Michler, R. E.; Michler, Robert E.

In: Cancer, Vol. 72, No. 9, 1993, p. 2782-2785.

Research output: Contribution to journalArticle

Garrett, TJ, Chadburn, A, Barr, ML, Drusin, RE, Chen, JM, Schulman, LL, Smith, CR, Reison, DS, Rose, EA, Michler, RE & Michler, RE 1993, 'Posttransplantation lymphoproliferative disorders treated with cyclophosphamide-doxorubicin-vincristine-prednisone chemotherapy', Cancer, vol. 72, no. 9, pp. 2782-2785. https://doi.org/10.1002/1097-0142(19931101)72:9<2782::AID-CNCR2820720941>3.0.CO;2-H
Garrett, T. J. ; Chadburn, A. ; Barr, M. L. ; Drusin, R. E. ; Chen, J. M. ; Schulman, L. L. ; Smith, C. R. ; Reison, D. S. ; Rose, E. A. ; Michler, R. E. ; Michler, Robert E. / Posttransplantation lymphoproliferative disorders treated with cyclophosphamide-doxorubicin-vincristine-prednisone chemotherapy. In: Cancer. 1993 ; Vol. 72, No. 9. pp. 2782-2785.
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abstract = "Background. Posttransplantation lymphoproliferative disorders after solid organ transplantation are a serious complication occurring in 1-10{\%} of patients. Different therapies have been used, but the optimal treatment is unknown. There is relatively little information in the literature on the experience with cytotoxic chemotherapy. Methods. The disease stage of patients with biopsy-documented posttransplantation lymphoproliferative was determined with standard methods to establish the extent of the disease. Patients in whom the disease failed to regress after initial management, which included reduction in immunosuppression, were treated with a combination chemotherapy regimen consisting of six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Response to therapy was determined by following previously defined sites of disease with appropriate tests. Patients were maintained on a reduced dose of immunosuppressants. Results. In the four patients studied, lymphoproliferative disorders developed after heart (three cases) or lung (one case) transplantation, which did not regress after immunosuppression was reduced. All four experienced a complete remission with CHOP chemotherapy, which continued at 3, 13+, 20 and 30+ months after completion of treatment. One patient died of sepsis after completing therapy at a point when his leukocyte count was normal, and no evidence of posttransplantation lymphoproliferative disorder was found at autopsy. A second patient died of liver failure with no clinical evidence of lymphoproliferative disorder. Conclusion. Although this is a small series, it demonstrates that patients with posttransplantation lymphoproliferative disorders may respond to cytotoxic chemotherapy. The duration of response is undetermined.",
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AU - Garrett, T. J.

AU - Chadburn, A.

AU - Barr, M. L.

AU - Drusin, R. E.

AU - Chen, J. M.

AU - Schulman, L. L.

AU - Smith, C. R.

AU - Reison, D. S.

AU - Rose, E. A.

AU - Michler, R. E.

AU - Michler, Robert E.

PY - 1993

Y1 - 1993

N2 - Background. Posttransplantation lymphoproliferative disorders after solid organ transplantation are a serious complication occurring in 1-10% of patients. Different therapies have been used, but the optimal treatment is unknown. There is relatively little information in the literature on the experience with cytotoxic chemotherapy. Methods. The disease stage of patients with biopsy-documented posttransplantation lymphoproliferative was determined with standard methods to establish the extent of the disease. Patients in whom the disease failed to regress after initial management, which included reduction in immunosuppression, were treated with a combination chemotherapy regimen consisting of six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Response to therapy was determined by following previously defined sites of disease with appropriate tests. Patients were maintained on a reduced dose of immunosuppressants. Results. In the four patients studied, lymphoproliferative disorders developed after heart (three cases) or lung (one case) transplantation, which did not regress after immunosuppression was reduced. All four experienced a complete remission with CHOP chemotherapy, which continued at 3, 13+, 20 and 30+ months after completion of treatment. One patient died of sepsis after completing therapy at a point when his leukocyte count was normal, and no evidence of posttransplantation lymphoproliferative disorder was found at autopsy. A second patient died of liver failure with no clinical evidence of lymphoproliferative disorder. Conclusion. Although this is a small series, it demonstrates that patients with posttransplantation lymphoproliferative disorders may respond to cytotoxic chemotherapy. The duration of response is undetermined.

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KW - cardiac transplantation

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