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Case Reports in Transplantation
Volume 2015, Article ID 801082, 3 pages
http://dx.doi.org/10.1155/2015/801082
Case Report

Treatment of Recurrent Posttransplant Lymphoproliferative Disorder with Autologous Blood Stem Cell Transplant

1Department of Internal Medicine, University of Kansas School of Medicine-Wichita, 1010 N. Kansas Street, Wichita, KS 67214, USA
2Heartland Cardiology, Heartland West, 9000 W. Central, Wichita, KS 67212, USA
3Cancer Center of Kansas, 818 N. Emporia, No. 403, Wichita, KS 67214, USA

Received 4 August 2015; Revised 13 October 2015; Accepted 5 November 2015

Academic Editor: Mohammed Rafique Moosa

Copyright © 2015 Bharat Malhotra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Posttransplant lymphoproliferative disorders (PTLDs) occur after solid organ transplantation. Treatment guidelines include reduction in immunosuppression (RIS), radiation, rituximab, chemotherapy, and immunological agents. We present a rare case of recurrent diffuse large B-cell lymphoma presenting as a PTLD in a heart transplant patient treated with autologous blood stem cell transplant (ASCT) after failure of conventional therapy. Case Presentation. A 66-year-old male presented with a neck mass. He has a history of Hodgkin’s disease status after staging laparotomy with splenectomy and heart transplantation due to dilated nonischemic cardiomyopathy 8 years prior to the development of PTLD. His examination was remarkable for right submandibular swelling. An excisional biopsy confirmed the diagnosis of diffuse large B-cell NHL. Patient received RIS, rituximab, chemotherapy, and radiation therapy with a complete remission. His lymphoma relapsed and he subsequently was treated with RICE salvage chemotherapy and consolidative high-dose chemotherapy with BEAC regimen followed by ASCT resulting in a complete remission. Conclusion. Patients with PTLD present a difficult therapeutic challenge. In this case, the patient’s prior history of Hodgkin’s disease, splenectomy, and a heart transplant appear to be unique features, the significance of which is unclear. ASCT might be a promising therapy for patients with relapsed or refractory PTLD.