Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 748-757
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.748
Infectious complications during immunochemotherapy of post-transplantation lymphoproliferative disease–can we decrease the risk? Two case reports and review of literature
Aleksandra Gładyś, Sylwia Kozak, Kamil Wdowiak, Mateusz Winder, Jerzy Chudek
Aleksandra Gładyś, Sylwia Kozak, Kamil Wdowiak, Mateusz Winder, Jerzy Chudek, Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Katowice 40-027, Woj. śląskie, Poland
Author contributions: Gładyś A and Kozak S drafted this paper; Wdowiak K and Chudek J made critical revisions; Winder M selected images; Chudek J made final verification.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aleksandra Gładyś, N/A, N/A, Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Reymonta 8, Katowice 40-027, Woj. śląskie, Poland. aleksandragladys@outlook.com
Received: November 5, 2020
Peer-review started: November 5, 2020
First decision: November 23, 2020
Revised: December 2, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 26, 2021
Processing time: 75 Days and 15.1 Hours
Abstract
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 R-CODOX/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.

Keywords: Post-transplant lymphoproliferative disease; Lymphoma; Epstein-Barr virus; Immunosuppression; Transplantation; Case report

Core Tip: Post-transplant lymphoproliferative disease (PTLD) is a heterogeneous group of diseases in transplantated patients related to immunosuppression regimen, T-cell depletion and Epstein-Barr virus infection. Immunochemotherapy (ICHT) increases already high incidence of bacterial infections in transplanted patients related to the immunosuppression therapy. We report the successful management of two solid organ transplanted patients with PTLD and urinary and pulmonary tract infections infections during ICTH that developed regardless of the reduction of immunosuppression therapy, doses of chemotherapeutics and GCS-F used in the prevention of neutropenic fever. We show that all these interventions may be insufficient to prevent infectious complications, but they are manageable.