The kind and intensity of immunosuppression as well as Epstein-Barr virus, a transforming herpes virus that selectively infects B lymphocytes and causes infectious mononucleosis, have been implicated in the development of posttransplantation lymphproliferative disorders (PT-LPD), a life-threatening complication of solid organ transplantation. The morphologic spectrum of PT-LPD ranges from polymorphous hyperplasia to monomorphous B-non-Hodgkin lymphomas. Among different modalities of treatment, reduction of immunosuppression with or without coadministration of antiviral agents may result in PT-LPD regression especially in mononucleosis-like disease.
Nonmononucleosis-like PT-LPD in a simultaneous heart and renal recipient was treated with Foscarnet, a potent inhibitor of different herpes viruses with a low profile of toxicity, although intensive immunosuppression therapy was maintained.
A 4-week course of Foscarnet resulted in relapse-free complete remission (follow-up 10+ months). Thus, antiviral treatment with Foscarnet, may induce prolonged remission in non-mononucleosis-like PT-LPD without reduction of immunosuppression.
Department of Haematology and Oncology, Charite-Campus Virchow, Medizinische Fakultät der Humboldt Unversität, Augustenburger Platz 1, 13353 Berlin; Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin; and Institut of Pathology, Benjamin Franklin Clinic, Free University, Hindenburg Damm 30, 12200 Berlin, Germany
1 Department of Haematology and Oncology, Charite-Campus Virchow, Medizinische Fakultät der Humboldt Unversität.
2 Institut of Pathology, Benjamin Franklin Clinic, Free University.
3 Deutsches Herzzentrum Berlin.
4 Address correspondence to: Stephan Oertel, Charite-Campus Virchow, Hämatologie und Onkologie, Hämatologische Ambulanz, Augustenburger Platz 1, 13353 Berlin, Germany.
Received 21 July 1998.
Accepted 14 October 1998.