Abstract
Primary central nervous system (CNS) posttransplant lymphoproliferative disorder (PTLD) is a well-recognized but rare complication of solid organ transplantation. Most of these disorders are B-cell in origin and generally carry poor prognosis. Rituximab, an anti-CD20 monoclonal antibody, has been used effectively in patients with systemic PTLD. However, its role in primary CNS PTLD is doubtful because it does not cross blood–brain barrier efficiently (<5%). Also, mechanisms, by which rituximab operates are not optimally effective in CNS. Here, we describe a renal transplant patient with monomorphic, multifocal, CD20-positive, primary B-cell CNS PTLD, who was treated with high-dose intravenous rituximab given in dose-escalation protocol, which has been used effectively for the patients with chronic lymphocytic leukemia. At 1-year follow-up, magnetic resonance imaging (MRI) showed complete resolution. High-dose rituximab may have a role in highly selected patients with primary CNS PTLD.
This is a preview of subscription content, log in via an institution to check access.
References
Schneck SA, Penn I (1970) Cerebral neoplasms associated with renal transplantation. Arch Neurol 22:226–233
Phan TG, O’Neill BP, Kurtin PJ (2000) Posttransplant primary CNS lymphoma. Neurooncology 2:229–238
Snanoudj R, Durrbach A, Leblond V et al (2003) Primary brain lymphomas after kidney transplantation: presentation and outcome. Transplantation 76:930–937
Castellano-Sanchez AA, Li S, Qian J, Lagoo A, Weir E, Brat DJ (2004) Primary central nervous system posttransplant lymphoproliferative disorders. Am J Clin Pathol 121:246–253
Cavaliere R, Petroni G, Lopes M, Schiff D, The International Primary Central Nervous System Lymphoma Collaborative Group (2010) Primary central nervous system post-transplantation lymphoproliferative disorder. Cancer 116:863–870
Penn I, Porat G (1995) Central nervous system lymphomas in organ allograft recipients. Transplantation 59:240–244
Buell JF, Gross TG, Hanaway MJ et al (2005) Posttransplant lymphoproliferative disorder: significance of central nervous system involvement. Transplant Proc 37:954–955
Caillard S, Dharnidharka, Agodoa L, Bohen E, Abbott K (2005) Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation 80:1233–1243
Knight JS, Tsodikov A, Cibrik DM, Ross CW, Kaminski MS, Blayney DW (2009) Lymphoma after solid organ transplantation: risk, response to therapy, and survival at a transplant center. J Clin Oncol 27:3354–3362
Blaes AH, Peterson BA, Bartlett N et al (2005) Rituximab therapy is effective for posttransplant lymphoproliferative disorders after solid organ transplantation. Cancer 104:1661–1667
Choquet S, Leblond V, Herbrecht R et al (2006) Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of prospective multicenter phase 2 study. Blood 107:3053–3057
Gonzalez-Barca E, Domingo-Domenech E, Capote FJ et al (2007) Prospective phase II trial of extended treatment with rituximab in patients with B-cell post-transplant lymphoproliferative disease. Haematologica 92:1489–1494
Ruhstaller TW, Amsler U, Cerny T (2000) Rituximab: active treatment of central nervous system involvement by non-Hodgkin’s lymphoma. Ann Oncol 11:374–375
Harjunpaa A, Wiklund T, Collan J et al (2001) Complement activation in circulation and central nervous system after rituximab (anti-CD20) treatment of B-cell lymphoma. Leuk Lymphoma 42:731–738
Rubenstein JL, Combs D, Rosenberg J et al (2003) Rituximab therapy for CNS lymphoma: targeting the leptomeningeal compartment. Blood 101:466–468
Traum AZ, Rodig NM, Pilichowska ME, Somers MJG (2006) Central nervous system lymphoproliferative disorder in pediatric kidney transplant recipients. Pediatr Transplant 10:505–512
O’Brien SM, Kantarjian H, Thomas DA et al (2001) Rituximab dose escalation trial in chronic lymphocytic leukemia. J Clin Oncol 19:2165–2170
Kordelas L, Trenschel R, Koldehoff M, Elmaagacli A, Beelen DW (2008) Successful treatment of EBV PTLD with CNS lymphomas with the monoclonal anti-CD20 antibody rituximab. Onkologie 31:691–693
Schulz H, Pels H, Schmidt-Wolf I, Zeelen U, Germing U (2004) Intraventricular treatment of relapsed central nervous system lymphoma with the anti-CD20 antibody rituximab. Haematologica 89:753–754
Rubenstein JL, Fridlyand J, Abrey L et al (2007) Phase I study of intraventricular administration of rituximab in patients with recurrent CNS and intraocular lymphoma. J Clin Oncol 25:1350–1356
Wong ET, Tishler R, Barron L, Wu JK (2004) Immunochemotherapy with rituximab and temozolomide for central nervous system lymphomas. Cancer 101:139–145
Angelov L, Doolittle ND, Kraemer DF et al (2009) Blood brain barrier disruption and methotrexate-based therapy for newly diagnosed primary CNS lymphoma: a multi-iinstitutional experience. J Clin Oncol 27:3503–3509
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patrick, A., Wee, A., Hedderman, A. et al. High-dose intravenous rituximab for multifocal, monomorphic primary central nervous system posttransplant lymphoproliferative disorder. J Neurooncol 103, 739–743 (2011). https://doi.org/10.1007/s11060-010-0425-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-010-0425-0