BACKGROUND Post-transplant lymphoproliferative disease(PTLD)is a heterogeneous group of diseases that develop after solid organ and hematopoietic stem cells transplantation related to intensive immunosuppression regim...BACKGROUND Post-transplant lymphoproliferative disease(PTLD)is a heterogeneous group of diseases that develop after solid organ and hematopoietic stem cells transplantation related to intensive immunosuppression regimen,T-cell depletion and Epstein-Barr virus infection.Despite the improvement in the management of PTLD,the prognosis remains poor.Here we report the management of two transplanted patients with PTLD and infections during immunochemotherapy(ICTH).CASE SUMMARY Of 65-year-old woman 11 years after kidney transplantation(first case)presented with diffuse large B-cell lymphoma(DLBCL)CS III and started ICHT according to R-CHOP protocol.Despite the secondary prevention of neutropenic fever,the patient developed grade 4 neutropenia with urinary and pulmonary tract infections after the fifth cycle.ICTH was continued in reduced doses up to 7 cycles followed by involved-field radiation therapy of the residual disease.The second case presents a 49-year-old man,8 years after liver transplantation due to cirrhosis in the course of chronic hepatitis B,who started ICTH for DLBCL Burkitt-like CS IV.The patient received four cycles of ICTH according to RCODOX/R-IVAC protocol,with reduced doses.In both cases initially undertaken reduction of immunosuppression was ineffective to prevent infectious complications.Despite one incomplete ICHT treatment due to recurrent infections,both our patients remain in complete remission.CONCLUSION Reduction of immunosuppression and the doses of chemotherapeutics may be insufficient to prevent infectious complications during ICTH in PTLD patients.展开更多
BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impair...BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease.Colorectal cancer(CRC),frequently diagnosed in an advanced stage,is one of the most common malignancies in this cohort and is associated with poor prognosis.Still,because of the scarcity of data concerning adjuvant chemotherapy in this group,there are no clear guidelines for the specific management of the CRCs in KTRs.We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation(2005)because of end-stage kidney disease,secondary to chronic glomerular nephritis,and long-term immunosuppression was diagnosed with locally advanced pT_(4A)N_(1B) M_(0)(clinical stage Ⅲ)colon adenocarcinoma G2.After right hemicolectomy,the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin,leucovorin and 5-fluorouracil(FOLFOX-4).The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation ofhemodialysis therapy after a few months. Shortly after that, the patient started palliativechemotherapy because of cancer recurrence with intraperitoneal spread.CONCLUSIONInitiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft lossdriven also by under-immunosuppression。展开更多
文摘BACKGROUND Post-transplant lymphoproliferative disease(PTLD)is a heterogeneous group of diseases that develop after solid organ and hematopoietic stem cells transplantation related to intensive immunosuppression regimen,T-cell depletion and Epstein-Barr virus infection.Despite the improvement in the management of PTLD,the prognosis remains poor.Here we report the management of two transplanted patients with PTLD and infections during immunochemotherapy(ICTH).CASE SUMMARY Of 65-year-old woman 11 years after kidney transplantation(first case)presented with diffuse large B-cell lymphoma(DLBCL)CS III and started ICHT according to R-CHOP protocol.Despite the secondary prevention of neutropenic fever,the patient developed grade 4 neutropenia with urinary and pulmonary tract infections after the fifth cycle.ICTH was continued in reduced doses up to 7 cycles followed by involved-field radiation therapy of the residual disease.The second case presents a 49-year-old man,8 years after liver transplantation due to cirrhosis in the course of chronic hepatitis B,who started ICTH for DLBCL Burkitt-like CS IV.The patient received four cycles of ICTH according to RCODOX/R-IVAC protocol,with reduced doses.In both cases initially undertaken reduction of immunosuppression was ineffective to prevent infectious complications.Despite one incomplete ICHT treatment due to recurrent infections,both our patients remain in complete remission.CONCLUSION Reduction of immunosuppression and the doses of chemotherapeutics may be insufficient to prevent infectious complications during ICTH in PTLD patients.
文摘BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease.Colorectal cancer(CRC),frequently diagnosed in an advanced stage,is one of the most common malignancies in this cohort and is associated with poor prognosis.Still,because of the scarcity of data concerning adjuvant chemotherapy in this group,there are no clear guidelines for the specific management of the CRCs in KTRs.We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation(2005)because of end-stage kidney disease,secondary to chronic glomerular nephritis,and long-term immunosuppression was diagnosed with locally advanced pT_(4A)N_(1B) M_(0)(clinical stage Ⅲ)colon adenocarcinoma G2.After right hemicolectomy,the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin,leucovorin and 5-fluorouracil(FOLFOX-4).The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation ofhemodialysis therapy after a few months. Shortly after that, the patient started palliativechemotherapy because of cancer recurrence with intraperitoneal spread.CONCLUSIONInitiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft lossdriven also by under-immunosuppression。