Long-term maintenance therapy for postcardiac transplant monoclonal lymphoproliferative disorder: Caveat mammalian target of rapamycin

Z. Khalpey, D. V. Miller, J. D. Schmitto, S. S. Kushwaha

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

A 53-year-old Caucasian male suffering from idiopathic dilated cardiomyopathy underwent cardiac transplantation. Fifty-seven days following transplant, he developed posttransplant lymphoproliferative disorder (PTLD), which was Epstein-Barr virus positive. The initial episode of PTLD was treated with a dose reduction in cyclosporine (CsA) and a 4-week course of rituximab. Subsequent biopsies showed resolution of PTLD. One year posttreatment, his evaluation revealed severe cardiac allograft vasculopathy (CAV). The patient was switched to sirolimus-based immunosuppression regimen with gradual up-titration of sirolimus in combination with complete withdrawal of previously administered Calcineurin-based immunosuppression approach. The switchover was carried out over a 6-week period. In the following 3 years, there was CAV regression as well as PTLD remission, without any significant episode of rejection. Despite frequent relapses with this form of PTLD, the patient remains in remission, 8 years posttransplantation. In summary, sirolimus has been demonstrated to attenuate the progression of CAV, and this case report illustrates that regression of CAV is possible. In addition to preventing rejection, mammalian target of rapamycin inhibitors directly suppress signaling pathways leading to PTLD and may be effective monotherapy for preventing rejection and suppressing PTLD.

Original languageEnglish (US)
Pages (from-to)1893-1899
Number of pages7
JournalTransplantation Proceedings
Volume43
Issue number5
DOIs
StatePublished - Jun 1 2011

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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