Successful treatment of Epstein-Barr virus-associated primary central nervous system lymphoma due to post-transplantation lymphoproliferative disorder, with ibrutinib and third-party Epstein-Barr virus-specific T cells.
cancer / malignancy / neoplasia: hematogenous / leukemia / lymphoma
complication: malignant
dialysis: hemodialysis
hematology / oncology
immunobiology
infection and infectious agents - viral: Epstein-Barr Virus (EBV)
translational research / science
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
30
03
2021
received:
27
01
2021
accepted:
23
04
2021
pubmed:
5
5
2021
medline:
21
10
2021
entrez:
4
5
2021
Statut:
ppublish
Résumé
Primary central nervous system lymphoma (PCNSL) occurring following organ transplantation (post-transplantation lymphoproliferative disorder [PTLD]) is a highly aggressive non-Hodgkin lymphoma. It is typically treated with high-dose methotrexate-based regimens. Outcomes are dismal and clinical trials are lacking. It is almost always Epstein-Barr virus (EBV) associated. Two patients (CA1-2) presented with EBV-associated PCNSL after renal transplant. CA1 was on hemodialysis and had prior disseminated cryptococcus and pseudomonas bronchiectasis, precluding treatment with methotrexate. CA2 was refractory to methotrexate. Both were treated off-label with the first-generation Bruton's tyrosine kinase inhibitor ibrutinib for 12 months. Cerebrospinal fluid penetration at therapeutic levels was confirmed in CA1 despite hemodialysis. Both patients entered remission by 2 months. Sequencing confirmed absence of genetic aberrations in human leukocyte antigen (HLA) class I/II and antigen-presentation/processing genes, indicating retention of the ability to present EBV-antigens. Between Weeks 10 and 13, they received third-party EBV-specific T cells for consolidation with no adverse effects. They remain in remission ≥34 months since therapy began. The strength of these findings led to an ongoing phase I study (ACTRN12618001541291).
Identifiants
pubmed: 33942495
doi: 10.1111/ajt.16628
pii: S1600-6135(22)08767-6
doi:
Substances chimiques
Piperidines
0
ibrutinib
1X70OSD4VX
Adenine
JAC85A2161
Types de publication
Case Reports
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3465-3471Informations de copyright
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
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