High-dose intravenous methotrexate with high-flux, extended-hours haemodialysis in treatment of primary central nervous system, post-transplant lymphoproliferative disorder and end-stage kidney disease: A case report

Nephrology ◽  
2018 ◽  
Vol 23 (11) ◽  
pp. 1063-1064
Author(s):  
James Yeung ◽  
Erin Vaughan ◽  
Steven Chadban ◽  
John Saunders ◽  
Nisha Thiagarajah ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Kidney Disease ◽  
Lymphoproliferative Disorder ◽  
High Dose ◽  
High Flux ◽  
End Stage Kidney Disease ◽  
Post Transplant ◽  
End Stage

scholarly journals Effects of Hemodiafiltration and High Flux Hemodialysis on Nerve Excitability in End-Stage Kidney Disease

PLoS ONE ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. e59055 ◽  
Author(s):  
Ria Arnold ◽  
Bruce A. Pussell ◽  
Timothy J. Pianta ◽  
Virginija Grinius ◽  
Cindy S-Y. Lin ◽  
...  
Keyword(s):  
Kidney Disease ◽  
High Flux ◽  
End Stage Kidney Disease ◽  
Nerve Excitability ◽  
End Stage

scholarly journals Treatment of Recurrent Posttransplant Lymphoproliferative Disorder of the Central Nervous System with High-Dose Methotrexate

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Clare J. Twist ◽  
Ricardo O. Castillo
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Lymphoproliferative Disorder ◽  
Small Bowel Transplantation ◽  
Intestinal Transplantation ◽  
Complete Response ◽  
High Dose ◽  
Posttransplant Lymphoproliferative Disorder ◽  
Chop Chemotherapy ◽  
The Central Nervous System

Posttransplant lymphoproliferative disorder (PTLD) is a frequent complication of intestinal transplantation and is associated with a poor prognosis. There is currently no consensus on optimal therapy. Recurrent PTLD involving the central nervous system (CNS) represents a particularly difficult therapeutic challenge. We report the successful treatment of CNS PTLD in a pediatric patient after liver/small bowel transplantation. Initial immunosuppression (IS) was with thymoglobulin, solucortef, tacrolimus, and mycophenolate mofetil. EBV viremia developed 8 weeks posttransplantation, and despite treatment with cytogam and valganciclovir the patient developed a polymorphic, CD20+, EBV+ PTLD with peripheral lymphadenopathy. Following treatment with rituximab, the lymphadenopathy resolved, but a new monomorphic CD20−, EBV+, lambda-restricted, plasmacytoid PTLD mesenteric mass emerged. Complete response of this PTLD was achieved with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy; however, 4 months off therapy he developed CNS PTLD (monomorphic CD20−, EBV+, lambda-restricted, plasmacytoid PTLD) of the brain and spine. IS was discontinued and HD-MTX (2.5–5 gm/m2/dose) followed by intrathecal HD-MTX (2 mg/dose ×2-3 days Q 7–10 days per cycle) was administered Q 4–7 weeks. After 3 cycles of HD-MTX, the CSF was negative for malignant cells, MRI of head/spine showed near-complete response, and PET/CT was negative. The patient remains in complete remission now for 3.5 years after completion of systemic and intrathecal chemotherapy.Conclusion. HD-MTX is an effective therapy for CNS PTLD and recurrent PTLD that have failed rituximab and CHOP chemotherapy.

Intrathecal Rituximab for EBV-Associated Post-Transplant Lymphoproliferative Disorder with Central Nervous System Involvement Unresponsive to Intravenous Rituximab-Based Treatments: A Prospective Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4352-4352
Author(s):  
Qifa Liu ◽  
Meiqing Wu ◽  
Jing Sun ◽  
Yu Zhang ◽  
Fen Huang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Prospective Study ◽  
Lymphoproliferative Disorder ◽  
Conflicts Of Interest ◽  
Central Nervous System Involvement ◽  
Post Transplant ◽  
System Involvement ◽  
Dismal Prognosis ◽  
Significant Difference

Abstract Backgroud: Although the introduction of rituximab as a first-line treatment has improved outcome of post-transplant lymphoproliferative disorder (PTLD), PTLD with central nervous system involvement (CNS-PTLD) still has a dismal prognosis because of low penetrance across the blood-brain barrier. In this prospective study, we reported intrathecal rituximab was efficacy and safety in the patients with CNS-PTLD who had failed to respond to the intravenous rituximab-based treatments. Methods: From June 2009 to November 2013, 32 cases of EBV-associated PTLD were recorded in the Southern Medical University Institute of Hematology. Fourteen patients diagnosed with CNS-PTLD were enrolled in this prospective study. For the patients who failed to response to the initial intravenous rituximab-based treatments, sequential dose-escalation schedule of intrathecal rituximab (initial dose of 20mg, increased by 10mg each week and maximum dose of 50 mg) was administrated weekly. Results: Three patients were responsive and 11 were unresponsive to the initial treatments within one week after the treatments. For the 11 patients who failed to respond to the initial treatments, 9 patients received intrathecal rituximab within 7-11 days and 2 patients refused the treatment. After two cycles of rituximab-based treatments, 10 patients achieved complete response (CR), 2 patients were partial response and 2 patients were non-response. With a median follow up of 664 (range 18 to 1545) days after the diagnosis of CNS-PTLD, 7 patients survived and 7 died. The causes of death included PTLD progressing (n=3), PTLD relapse (n=1), GVHD (n=1), CMV pneumonia (n=1) and pseudomonas aeruginosa sepsis (n=1). The 3-year probability of OS was 45.7% ±14.7% in CNS-PTLD, which was no significant difference as compared to PTLD without CNS involvement(55.6% ±11.7%, P=0.706). Conclusion: Intrathecal rituximab might be an effective and safe method for CNS-PTLD in the allo-HSCT recipients who were unresponsive to the intravenous rituximab-based treatments. Disclosures No relevant conflicts of interest to declare.

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