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Notes: Abstract Kidney transplant patients may develop post-transplant erythremia (PTE), and in order to avoid thromboembolism venesection, anticoagulation and native kidney removal have been suggested. We propose captopril as an alternative therapy for PTE. Seven hypertensive PTE patients, aged 42±10 years with stable renal function, were investigated to exclude primary or secondary polycythemia. All patients manifested true erythrocytosis [red blood cells (RBC) mass〉20% of predicted level] with concomitant increases in hematocrit and hemoglobin levels. Captopril was introduced in gradually increasing doses up to 75 mg/day under careful monitoring of blood pressure and renal function. Weekly follow-up was arranged to evaluate drug efficacy. After captopril, a significant reduction with normalization of the RBC mass (42±4 vs 31±5 ml/kg; P〈0.005) was observed. The RBC counts and hematocrit and hemoglobin levels also decreased. One patient had recurrent erythrocytosis after captopril withdrawal. Captopril may be a simple, effective, and non aggressive treatment for postrenal transplant erythremia.

Notes: Abstract Background:B-lymphoproliferative post-transplant disorder (BLPD)is a severe complication of organ and bone marrow transplantation. Thereduction of immuno-suppressive therapy or surgery for localized disease maycure some BLPDs. Other therapeutic approaches such as chemotherapy andantiviral drugs are toxic and of limited efficacy. Adoptive immunotherapy withdonor T-cell infusions has yielded promising results but is, at the presenttime, easily applicable only in bone marrow-transplanted patients. Anti-B-cellMurine monoclonal antibodies (MoAbs) have proven effective but are no longeravailable for human use. We report the activity of a humanized anti CD 20 MoAb (Rituximab–MABTHERA® Roche) in 32 episodes of BLPD treated in 14French centers. Patients and methods:Between November 1997 and September 1998,32 patients were diagnosed with BLPD. Twenty-six patients had undergone solidorgan transplants (liver 8, kidney 8, heart 4, lung 3, heart lung 1,kidney-pancreas 1, liver-kidney 1) and six patients had received bone marrowtransplantations. The median age of the patients was 34 years (3–67years) and the median delay between graft and tumor 5 months (1–156months). In organ recipients, tumors were classified as polymorphic andmonomorphic in 10 and 15 cases, respectively; 4 of 6 bone marrow transplantrecipients were treated without pathology documentation because of a rise inEBV load, fever and lymph node enlargement. Tumors were associated with EBVin 22 of 26 tested cases. Rituximab was used as first-line therapy in 30patients (after reduction of immunosuppressive treatment in 27 patients) andas salvage therapy in 2 patients (after failure of chemotherapy). The mediantime from diagnosis of BLPD to treatment with Rituximab was 14 days(1–110 days). Two patients received eight infusions, twenty-six patientsfour infusions, one patient three infusions and three patients two infusionsof 375 mg/m2. Results:The tolerance of rituximab was good. The overall responserate was 69%, with 20 complete responses and 2 partial responses. Insolid organ transplant the response rate was 65% (15 CR and 2 PR) whileit was 83% in bone marrow-transplanted patients (5 CR). With a medianfollow-up of 8 months (1–16 months) 24 patients are still alive. Theone-year projected survival is 73%. Of the 22 patients who achievedresponse, 15 patients (11 solid organ transplant and 4 bone marrow transplant)are alive with no evidence of disease, 4 patients relapsed a median of 7months (3–10 months) after treatment and 3 died while in CR ofconcurrent diseases. Of the 10 patients who did not respond to Rituximab 5 arealive with no evidence of disease after salvage therapy. Conclusions:The use of rituximab appears to be a safe andrelatively efficient therapy in BLPDs. The results need to be confirmed in aprospective multicentric trial.