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Section editor transclusions Post-transplant lymphoproliferative disorder (PTLD) of the monomorphic variety is typically treated as per the histologic subtype, which is usually diffuse large B-cell lymphoma (DLBCL). However, some regimens specific to PTLD have been developed, primarily due to concern of excess infectious toxicities in the setting of immunosuppression, and are included here.

7 regimens on this page 9 variants on this page

Induction

ACVBP, dose-adjusted

ACVBP: Adriamycin (Doxorubicin), Cyclophosphamide, Vindesine, Bleomycin, Prednisone

Regimen

Study	Years of enrollment	Evidence
Fohrer et al. 2006	1989-2003	Phase 2

Note: This is of historical interest, only.

Chemotherapy

Glucocorticoid therapy

Prednisone (Sterapred)

References

Fohrer C, Caillard S, Koumarianou A, Ellero B, Woehl-Jaeglé ML, Meyer C, Epailly E, Chenard MP, Lioure B, Natarajan-Ame S, Maloisel F, Lutun P, Kessler R, Moulin B, Bergerat JP, Wolf P, Herbrecht R. Long-term survival in post-transplant lymphoproliferative disorders with a dose-adjusted ACVBP regimen. Br J Haematol. 2006 Sep;134(6):602-12. Epub 2006 Aug 2. link to original article PubMed

Rituximab monotherapy

Protocol variant #1, 4-week course

Study	Years of enrollment	Evidence
Oertel et al. 2005	1999-2002	Phase 2, <20 pts
Choquet et al. 2005	2000-2001	Phase 2
González-Barca et al. 2007	2000-2005	Phase 2
Trappe et al. 2011 (PTLD-1)	2002-2008	Phase 2

Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

4-week course

Subsequent treatment

González-Barca et al. 2007: Patients underwent interim staging 4 to 8 weeks later
- Those achieving CR: no further treatment
- Those achieving PR: Rituximab consolidation
PTLD-1: Patients underwent interim staging by CT between days 40 and 50
- Those achieving CR: Rituximab consolidation
- All others: R-CHOP

Regimen variant #2, q6mo blocks

Study	Years of enrollment	Evidence
Blaes et al. 2005	1999-2001	Phase 2, <20 pts

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

6-month cycle for up to 4 cycles (2 years)

References

Blaes AH, Peterson BA, Bartlett N, Dunn DL, Morrison VA. Rituximab therapy is effective for posttransplant lymphoproliferative disorders after solid organ transplantation: results of a phase II trial. Cancer. 2005 Oct 15;104(8):1661-7. link to original article contains dosing details in abstract PubMed
Oertel SH, Verschuuren E, Reinke P, Zeidler K, Papp-Váry M, Babel N, Trappe RU, Jonas S, Hummel M, Anagnostopoulos I, Dörken B, Riess HB. Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant. 2005 Dec;5(12):2901-6. link to original article contains dosing details in abstract PubMed
1. Pooled update: Choquet S, Oertel S, LeBlond V, Riess H, Varoqueaux N, Dörken B, Trappe RU. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol. 2007 Aug;86(8):599-607. Epub 2007 May 24. link to original article PubMed
Choquet S, Leblond V, Herbrecht R, Socié G, Stoppa AM, Vandenberghe P, Fischer A, Morschhauser F, Salles G, Feremans W, Vilmer E, Peraldi MN, Lang P, Lebranchu Y, Oksenhendler E, Garnier JL, Lamy T, Jaccard A, Ferrant A, Offner F, Hermine O, Moreau A, Fafi-Kremer S, Morand P, Chatenoud L, Berriot-Varoqueaux N, Bergougnoux L, Milpied N. Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of a prospective multicenter phase 2 study. Blood. 2006 Apr 15;107(8):3053-7. Epub 2005 Oct 27. link to original article contains dosing details in abstract PubMed
1. Pooled update: Choquet S, Oertel S, LeBlond V, Riess H, Varoqueaux N, Dörken B, Trappe RU. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol. 2007 Aug;86(8):599-607. Epub 2007 May 24. link to original article PubMed
González-Barca E, Domingo-Domenech E, Capote FJ, Gómez-Codina J, Salar A, Bailen A, Ribera JM, López A, Briones J, Muñoz A, Encuentra M, de Sevilla AF; GEL/TAMO (Grupo Español de Linfomas); GELCAB (Grupo para el Estudio de los Linfomas Catalano-Balear); GOTEL (Grupo Oncológico para el Tratamiento y Estudio de los Linfomas). Prospective phase II trial of extended treatment with rituximab in patients with B-cell post-transplant lymphoproliferative disease. Haematologica. 2007 Nov;92(11):1489-94. link to original article contains dosing details in manuscript PubMed
PTLD-1: Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. link to original article contains dosing details in manuscript PubMed NCT01458548
1. Update: Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 link to original article contains dosing details in manuscript PubMed

R, then CHOP

R, then CHOP: Rituximab followed by Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne

Protocol

Study	Years of enrollment	Evidence
Trappe et al. 2011 (PTLD-1)	2002-2008	Phase 2

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

4-week course, followed in 4 weeks by:

Chemotherapy

Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 50 mg/m² PO once per day on days 1 to 5

Supportive therapy

G-CSF was required
PJP prophylaxis was recommended

21-day cycle for 4 cycles

References

PTLD-1: Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. link to original article contains dosing details in manuscript PubMed NCT01458548

R-CP

R-CP: Rituximab, Cyclophosphamide, Prednisone or Prednisolone

Regimen

Study	Years of enrollment	Evidence
Gross et al. 2012 (COG ANHL0221)	2004-2008	Phase 2

Note: This regimen was intended for patients less than 30 years of age.

Targeted therapy

Rituximab (Rituxan) as follows:
- Cycles 1 & 2: 375 mg/m² IV once per day on days 1, 8, 15

Chemotherapy

Cyclophosphamide (Cytoxan) 600 mg/m² IV once on day 1

Glucocorticoid therapy

ONE of the following steroids:
- Prednisone (Sterapred) 1 mg/kg PO twice per day on days 1 to 5
- Methylprednisolone (Solumedrol) 0.8 mg/kg IV every 12 hours on days 1 to 5

21-day cycle for 6 cycles

References

COG ANHL0221: Gross TG, Orjuela MA, Perkins SL, Park JR, Lynch JC, Cairo MS, Smith LM, Hayashi RJ. Low-dose chemotherapy and rituximab for posttransplant lymphoproliferative disease (PTLD): a Children's Oncology Group Report. Am J Transplant. 2012 Nov;12(11):3069-75. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00066469

Reduction of immunosuppression

RIS: Reduction of ImmunoSuppression

Regimen

Study	Evidence
Starzl et al. 1984	Case series
Reshef et al. 2011	Retrospective

No antineoplastic therapy, treatment consists of reduction or discontinuation (a.k.a., "withdrawal") of immunosuppressive medications.

References

Case series: Starzl TE, Nalesnik MA, Porter KA, Ho M, Iwatsuki S, Griffith BP, Rosenthal JT, Hakala TR, Shaw BW Jr, Hardesty RL, Jaffe R, Bahnson HT. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet. 1984 Mar 17;1(8377):583-7. link to original article link to PMC article PubMed
Retrospective: Reshef R, Vardhanabhuti S, Luskin MR, Heitjan DF, Hadjiliadis D, Goral S, Krok KL, Goldberg LR, Porter DL, Stadtmauer EA, Tsai DE. Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder. Am J Transplant. 2011 Feb;11(2):336-47. Epub 2011 Jan 10. link to original article link to PMC article PubMed

Consolidation after upfront therapy

Rituximab monotherapy

Protocol variant #1, q3wk x 4

Study	Years of enrollment	Evidence
Trappe et al. 2011 (PTLD-1)	2002-2008	Phase 2

Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.

Preceding treatment

Rituximab x 4, with CR

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once on day 1

21-day cycle for 4 cycles

Protocol variant #2, 4-week course

Study	Years of enrollment	Evidence
González-Barca et al. 2007	2000-2005	Phase 2

Preceding treatment

Rituximab x 4, with PR

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

4-week course

References

González-Barca E, Domingo-Domenech E, Capote FJ, Gómez-Codina J, Salar A, Bailen A, Ribera JM, López A, Briones J, Muñoz A, Encuentra M, de Sevilla AF; GEL/TAMO (Grupo Español de Linfomas).; GELCAB (Grupo para el Estudio de los Linfomas Catalano-Balear).; GOTEL (Grupo Oncológico para el Tratamiento y Estudio de los Linfomas). Prospective phase II trial of extended treatment with rituximab in patients with B-cell post-transplant lymphoproliferative disease. Haematologica. 2007 Nov;92(11):1489-94. link to original article contains dosing details in manuscript PubMed
PTLD-1: Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. link to original article contains dosing details in manuscript PubMed NCT01458548
1. Update: Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 link to original article contains dosing details in manuscript PubMed

R-CHOP

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Regimen

Study	Years of enrollment	Evidence
Trappe et al. 2011 (PTLD-1)	2002-2008	Phase 2

Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.

Preceding treatment

Rituximab x 4, without achievement of CR

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once on day 1

Chemotherapy

Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2 mg) IV once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 50 mg/m² PO once per day on days 1 to 5

Supportive therapy

G-CSF was required
PJP prophylaxis was recommended

21-day cycle for 4 cycles

References

PTLD-1: Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. link to original article contains dosing details in manuscript PubMed NCT01458548
1. Update: Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 link to original article contains dosing details in manuscript PubMed

Subsequent lines of therapy

Tabelecleucel

Regimen

Study	Years of enrollment	Evidence
Awaiting publication (ALLELE)	2017-NR	Non-randomized Phase 3

Immunotherapy

Tabelecleucel (Ebvallo)

References

ALLELE: NCT03394365

@@ Line 12: / Line 12: @@
 {{TOC limit|limit=3}}
 =Induction=
 ==ACVBP, dose-adjusted {{#subobject:bb17b2|Regimen=1}}==
 ACVBP: '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''indesine, '''<u>B</u>'''leomycin, '''<u>P</u>'''rednisone
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:1cd335|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 28: / Line 27: @@
 |}
 ''Note: This is of historical interest, only.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Doxorubicin (Adriamycin)]]
@@ Line 35: / Line 35: @@
 ====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]]
+</div></div>
 ===References===
 # Fohrer C, Caillard S, Koumarianou A, Ellero B, Woehl-Jaeglé ML, Meyer C, Epailly E, Chenard MP, Lioure B, Natarajan-Ame S, Maloisel F, Lutun P, Kessler R, Moulin B, Bergerat JP, Wolf P, Herbrecht R. Long-term survival in post-transplant lymphoproliferative disorders with a dose-adjusted ACVBP regimen. Br J Haematol. 2006 Sep;134(6):602-12. Epub 2006 Aug 2. [https://doi.org/10.1111/j.1365-2141.2006.06228.x link to original article] [https://pubmed.ncbi.nlm.nih.gov/16889621 PubMed]
 ==Rituximab monotherapy {{#subobject:514479|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #1, 4-week course {{#subobject:513282|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 65: / Line 64: @@
 |}
 ''Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 '''4-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *González-Barca et al. 2007: Patients underwent interim staging 4 to 8 weeks later
@@ Line 76: / Line 77: @@
 **Those achieving CR: [[#Rituximab_monotherapy_2|Rituximab]] consolidation
 **All others: [[#R-CHOP|R-CHOP]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, q6mo blocks {{#subobject:9f729f|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 88: / Line 90: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 '''6-month cycle for up to 4 cycles (2 years)'''
+</div></div>
 ===References===
 # Blaes AH, Peterson BA, Bartlett N, Dunn DL, Morrison VA. Rituximab therapy is effective for posttransplant lymphoproliferative disorders after solid organ transplantation: results of a phase II trial. Cancer. 2005 Oct 15;104(8):1661-7. [https://doi.org/10.1002/cncr.21391 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/16149091 PubMed]
@@ Line 102: / Line 104: @@
 # '''PTLD-1:''' Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. [https://doi.org/10.1016/S1470-2045(11)70300-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22173060 PubMed] NCT01458548
 ## '''Update:''' Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 [https://doi.org/10.1200/JCO.2016.69.3564 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27992268 PubMed]
 ==R, then CHOP {{#subobject:f84777|Regimen=1}}==
 R, then CHOP: '''<u>R</u>'''ituximab followed by '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''redniso(lo)ne
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:a97899|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 117: / Line 118: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 '''4-week course, followed in 4 weeks by:'''
 ====Chemotherapy====
 *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
@@ Line 128: / Line 128: @@
 ====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 50 mg/m<sup>2</sup> PO once per day on days 1 to 5
 ====Supportive therapy====
 *[[:Category:Granulocyte colony-stimulating factors|G-CSF]] was required
 *[[:Category:PCP prophylaxis|PJP prophylaxis]] was recommended
 '''21-day cycle for 4 cycles'''
+</div></div>
 ===References===
 # '''PTLD-1:''' Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. [https://doi.org/10.1016/S1470-2045(11)70300-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22173060 PubMed] NCT01458548
 ==R-CP {{#subobject:2de85f|Regimen=1}}==
 R-CP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>P</u>'''rednisone or Prednisolone
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:affa46|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 153: / Line 150: @@
 |}
 ''Note: This regimen was intended for patients less than 30 years of age.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] as follows:
@@ Line 162: / Line 160: @@
 **[[Prednisone (Sterapred)]] 1 mg/kg PO twice per day on days 1 to 5
 **[[Methylprednisolone (Solumedrol)]] 0.8 mg/kg IV every 12 hours on days 1 to 5
 '''21-day cycle for 6 cycles'''
+</div></div>
 ===References===
 # '''COG ANHL0221:''' Gross TG, Orjuela MA, Perkins SL, Park JR, Lynch JC, Cairo MS, Smith LM, Hayashi RJ. Low-dose chemotherapy and rituximab for posttransplant lymphoproliferative disease (PTLD): a Children's Oncology Group Report. Am J Transplant. 2012 Nov;12(11):3069-75. [https://doi.org/10.1111/j.1600-6143.2012.04206.x link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484187/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/22883417 PubMed] NCT00066469
 ==Reduction of immunosuppression {{#subobject:1d45b7|Regimen=1}}==
 RIS: '''<u>R</u>'''eduction of '''<u>I</u>'''mmuno'''<u>S</u>'''uppression
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:7b1583|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 184: / Line 180: @@
 |}
 ''No antineoplastic therapy, treatment consists of reduction or discontinuation (a.k.a., "withdrawal") of immunosuppressive medications.''
+</div></div>
 ===References===
 # '''Case series:''' Starzl TE, Nalesnik MA, Porter KA, Ho M, Iwatsuki S, Griffith BP, Rosenthal JT, Hakala TR, Shaw BW Jr, Hardesty RL, Jaffe R, Bahnson HT. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet. 1984 Mar 17;1(8377):583-7. [https://doi.org/10.1016/S0140-6736(84)90994-2 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987704/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/6142304 PubMed]
 # '''Retrospective:''' Reshef R, Vardhanabhuti S, Luskin MR, Heitjan DF, Hadjiliadis D, Goral S, Krok KL, Goldberg LR, Porter DL, Stadtmauer EA, Tsai DE. Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder. Am J Transplant. 2011 Feb;11(2):336-47. Epub 2011 Jan 10. [https://doi.org/10.1111/j.1600-6143.2010.03387.x link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079420/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21219573 PubMed]
 =Consolidation after upfront therapy=
 ==Rituximab monotherapy {{#subobject:57gy79|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #1, q3wk x 4 {{#subobject:51ajbc2|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 205: / Line 199: @@
 |}
 ''Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Rituximab_monotherapy|Rituximab]] x 4, with CR
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
 '''21-day cycle for 4 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #2, 4-week course {{#subobject:7euba9|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 223: / Line 220: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Rituximab_monotherapy|Rituximab]] x 4, with PR
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 '''4-week course'''
+</div></div>
 ===References===
 # González-Barca E, Domingo-Domenech E, Capote FJ, Gómez-Codina J, Salar A, Bailen A, Ribera JM, López A, Briones J, Muñoz A, Encuentra M, de Sevilla AF; GEL/TAMO (Grupo Español de Linfomas).; GELCAB (Grupo para el Estudio de los Linfomas Catalano-Balear).; GOTEL (Grupo Oncológico para el Tratamiento y Estudio de los Linfomas). Prospective phase II trial of extended treatment with rituximab in patients with B-cell post-transplant lymphoproliferative disease. Haematologica. 2007 Nov;92(11):1489-94. [http://www.haematologica.org/content/92/11/1489.long link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/18024397 PubMed]
 # '''PTLD-1:''' Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. [https://doi.org/10.1016/S1470-2045(11)70300-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22173060 PubMed] NCT01458548
 ## '''Update:''' Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 [https://doi.org/10.1200/JCO.2016.69.3564 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27992268 PubMed]
 ==R-CHOP {{#subobject:32c6a1|Regimen=1}}==
 R-CHOP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin), '''<u>O</u>'''ncovin (Vincristine), '''<u>P</u>'''rednisone
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:84bd21|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 250: / Line 248: @@
 |}
 ''Note: This regimen was intended for B-cell PTLD. Note that this was a modification of the original PTLD-1 trial schema.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Rituximab_monotherapy|Rituximab]] x 4, without achievement of CR
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
@@ Line 260: / Line 261: @@
 ====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 50 mg/m<sup>2</sup> PO once per day on days 1 to 5
 ====Supportive therapy====
 *[[:Category:Granulocyte colony-stimulating factors|G-CSF]] was required
 *[[:Category:PCP prophylaxis|PJP prophylaxis]] was recommended
 '''21-day cycle for 4 cycles'''
+</div></div>
 ===References===
 # '''PTLD-1:''' Trappe RU, Oertel S, Leblond V, Mollee P, Sender M, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Salles G, Morschhauser F, Jaccard A, Lamy T, Leithäuser M, Zimmermann H, Anagnostopoulos I, Raphael M, Riess H, Choquet S; German PTLD Study Group.; European PTLD Network. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb;13(2):196-206. Epub 2011 Dec 13. [https://doi.org/10.1016/S1470-2045(11)70300-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22173060 PubMed] NCT01458548
 ## '''Update:''' Trappe RU, Dierickx D, Zimmermann H, Morschhauser F, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Reinke P, Verhoef G, Subklewe M, Hüttmann A, Tousseyn T, Salles G, Kliem V, Hauser IA, Tarella C, Van Den Neste E, Gheysens O, Anagnostopoulos I, Leblond V, Riess H, Choquet S. Response to rituximab induction is a predictive marker in B-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial. J Clin Oncol. 2017 Feb 10;35(5):536-43. Epub 2016 Dec 19 [https://doi.org/10.1200/JCO.2016.69.3564 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27992268 PubMed]
 =Subsequent lines of therapy=
 ==Tabelecleucel {{#subobject:32c6a1|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:84bd21|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 284: / Line 283: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Immunotherapy====
 *[[Tabelecleucel (Ebvallo)]]
+</div></div>
 ===References===
 #'''ALLELE:''' NCT03394365

Difference between revisions of "Post-transplant lymphoproliferative disorder"

Revision as of 01:21, 4 February 2023

Induction

ACVBP, dose-adjusted

Regimen

Chemotherapy

Glucocorticoid therapy

References

Rituximab monotherapy

Protocol variant #1, 4-week course

Targeted therapy

Subsequent treatment

Regimen variant #2, q6mo blocks

Targeted therapy

References

R, then CHOP

Protocol

Targeted therapy

Chemotherapy

Glucocorticoid therapy

Supportive therapy

References

R-CP

Regimen

Targeted therapy

Chemotherapy

Glucocorticoid therapy

References

Reduction of immunosuppression

Regimen

References

Consolidation after upfront therapy

Rituximab monotherapy

Protocol variant #1, q3wk x 4

Preceding treatment

Targeted therapy

Protocol variant #2, 4-week course

Preceding treatment

Targeted therapy

References

R-CHOP

Regimen

Preceding treatment

Targeted therapy

Chemotherapy

Glucocorticoid therapy

Supportive therapy

References

Subsequent lines of therapy

Tabelecleucel

Regimen

Immunotherapy

References

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