Virginia Commonwealth University School of Medicine, Richmond, Virginia.
INOVA Hematology Oncology, Falls Church, Virginia.
Transpl Infect Dis. 2020 Aug;22(4):e13265. doi: 10.1111/tid.13265. Epub 2020 Feb 27.
Incidence of Burkitt's lymphoma post-transplant lymphoproliferative disorder (BL-PTLD) in solid organ transplant (SOT) recipients in 1.4%-1.6% with unknown cure rate. We report a case of Epstein-Barr virus (EBV) positive, late-onset BL-PTLD in a 24-year-old EBV donor positive/recipient negative female. This is the first reported case of advanced BL-PTLD post-heart transplant in an adult. This is also the first reported case of treatment of advanced BL-PTLD in a heart transplant recipient with a combined chemotherapy regimen without anthracyclines to avoid cardiotoxicity. The patient received 6 cycles of R-COEP (rituximab with cyclophosphamide, vincristine, etoposide, prednisone) over 6 months and subsequently 3 cycles of high-dose methotrexate (MTX) over 3 months for CNS prophylaxis. She remains without evidence of disease at 19 months post-treatment. This case demonstrates that an anthracycline-free regimen can be the therapy option for patients with BL-PTLD after heart transplantation.
在实体器官移植（SOT）受者中，伯基特淋巴瘤移植后淋巴组织增生性疾病（BL-PTLD）的发病率为 1.4%-1.6%，其治愈率未知。我们报告了一例 EBV 阳性、迟发性 BL-PTLD 病例，发生于一名 24 岁 EBV 供者阳性/受者阴性的女性。这是首例成人心脏移植后发生晚期 BL-PTLD 的报道。这也是首例报道的在心脏移植受者中使用不含蒽环类药物的联合化疗方案治疗晚期 BL-PTLD 的病例，以避免心脏毒性。该患者在 6 个月内接受了 6 个周期的 R-COEP（利妥昔单抗联合环磷酰胺、长春新碱、依托泊苷、泼尼松）治疗，随后在 3 个月内接受了 3 个周期的高剂量甲氨蝶呤（MTX）治疗，以预防中枢神经系统疾病。治疗后 19 个月，她仍无疾病证据。该病例表明，对于心脏移植后发生 BL-PTLD 的患者，无蒽环类药物方案可以作为一种治疗选择。
