Treatment of EBV-related post-renal transplant lymphoproliferative disease with a tailored regimen including EBV-specific T cells

Patrizia Comoli, Rita Maccario, Franco Locatelli, Umberto Valente, Sabrina Basso, Alberto Garaventa, Paolo Tomà, Gerardo Botti, Giovanni Melioli, Fausto Baldanti, Arcangelo Nocera, Francesco Perfumo, Fabrizio Ginevri

Research output: Contribution to journalArticle

Abstract

The treatment of EBV-associated post-transplant lymphoproliferative disease (PTLD) poses a considerable challenge. Efforts have been made to define regimens based on combination of the available therapeutic agents, chosen and tailored on a patient-by-patient basis, with the aim of augmenting event-free patient and graft survival. Recently, autologous EBV-specific cytotoxic T-lymphocytes (CTL) have proved effective in enhancing EBV-specific immune responses and reducing viral load in organ transplant recipients with active infection. We investigated the use of a tailored combined approach including autologous EBV-specific CTL for the treatment of EBV-related PTLD developing after pediatric kidney transplantation. Five patients with disseminated monoclonal (n = 3) or localized polyclonal (n = 2) PTLD unresponsive to reduction of immunosuppression were enrolled. The patients with disseminated PTLD received 4-5 courses of reduced-dosage polychemotherapy, accompanied by rituximab on the first day of each course, while localized disease was removed, surgically. At treatment completion, autologous EBV-specific CTL were infused. All patients showed a complete response to treatment, without therapy-related toxicity or rejection, and persist in remission with good renal function at a median follow-up of 31 months. These preliminary results suggest that a combined chemoimmunotherapy regimen including virus-specific T-cells is well tolerated and potentially effective as first-line treatment of EBV-related PTLD.

Original languageEnglish
Pages (from-to)1415-1422
Number of pages8
JournalAmerican Journal of Transplantation
Volume5
Issue number6
DOIs
Publication statusPublished - Jun 2005

Keywords

  • Cytotoxic T lymphocytes
  • Epstein-Barr virus
  • Pediatric kidney transplantation
  • Post-transplant lymphoproliferative disorder

ASJC Scopus subject areas

  • Immunology

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