Calcineurin inhibitor-free graft-versus-host disease prophylaxis with sirolimus and mycophenolate mofetil in a second allogeneic stem cell transplantation for engraftment failure and rituximab-refractory Epstein-Barr virus-induced posttransplant lymphoproliferative disease.

Calcineurin inhibitor-free graft-versus-host disease prophylaxis with sirolimus and mycophenolate mofetil in a second allogeneic stem cell transplantation for engraftment failure and rituximab-refractory Epstein-Barr virus-induced posttransplant lymphoproliferative disease.

J Pediatr Hematol Oncol. 2014 Jul;36(5):e319-21

Authors: Ceppi F, Duval M, Teira P, Therrien R, Ovetchkine P, Mallette B, Bittencourt H

Abstract
Posttransplant lymphoproliferative disease (PTLD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. We describe here the case of a boy with history of induction failure of a T-cell acute lymphoblastic leukemia, who presented a life-threatening situation of nonengraftment and rituximab-refractory PTLD after the first hematopoietic stem cell transplantation. We decided to use an unusual strategy of combining a nonmyeloablative conditioning (fludarabine and cyclophosphamide) with a calcineurin inhibitor-free GvHD prophylaxis (sirolimus and mycophenolate mofetil). This strategy had permitted the control of an Epstein-Barr virus PLTD in umbilical cord blood transplantation without further reactivation.

PMID: 24977404 [PubMed - indexed for MEDLINE]



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