Aggressive Treatment for Postcardiac Transplant Lymphoproliferation

Posttransplant lymphoproliierative disorder (PTLD) is a fre-quently fatal complication of organ transplantation, OC-curring in 2 % to 696 of cardiac recipients. Treatment remains poorly defined. Reduction in immunosuppression is effective in a proportion of cases, but mortality on the order of 80% is reported for patients requiring chemotherapy. The reason for such poor outcomes is unclear, but may be partly caused by the concomitant use of immunosuppressives. Nineteen consecutive cardiac recipients with PTLD were studied retro-spectively in terms of clinical features and outcome. Patients were managed according t o a uniform treatment approach. Initial therapy was a trial of reduced immunosuppression with concomitant acyclovir followed, if unsuccessful, by ag-gressive combination chemotherapy. The regimen used was predominantly ProMACE-CytaBOM. Six patients with phe