EBV-positive central nervous system lymphoproliferative disease associated with immunosuppression after organ transplantation: Long-term remission without chemotherapy

• Main Authors: O A Gavrilina, V V Troitskaya, E E Zvonkov, E N Parovichnikova, G M Galstyan, L S Biryukova, I V Nesterenko, A M Kovrigina, A V Bazhenov, V G Savchenko
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2017-07-01
• Series: Терапевтический архив
• Subjects: diffuse large b-cell lymphoma involving the central nervous system; posttransplant lymphoproliferative diseases; kidney transplantation; immunosuppressive therapy
• Online Access: https://ter-arkhiv.ru/0040-3660/article/viewFile/32285/pdf
• ISSN: 0040-3660; 2309-5342

Primary central nervous system (CNS) lymphomas account for 13-20% of the posttransplant lymphoproliferative disorders (PTLD) and rank among the most aggressive conditions. Reduction of immunosuppressive therapy should be mandatory to treat PTLD, but this is rarely used as the only therapy option. Chemotherapy regimens for PTLD involving the CNS most commonly include high-dose rituximab and high-dose methotrexate and/or cytarabine. The efficiency only of discontinuation of immunosuppressive therapy for PTLD does not exceed 5—10%, but there are no literature data on its efficiency for PTLD involving the CNS. The paper describes a clinical case of achieving long-term remission in a female patient with Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma involving the central nervous system, associated with immunosuppression after kidney transplantation from a related donor, in the absence of chemotherapy during immunosuppressive therapy discontinuation and transplantectomy.