Monotherapy with Anti-CD20 Monoclonal Antibody in a Heart Transplant Recipient with Sick Sinus Syndrome and Posttransplantation Lymphoproliferative Disorder: A Case Report

Authors

  • Hsiang-Yu Yang
  • Hung-Yen Ke
  • Gou-Jieng Hong
  • Yi-Ting Tsai
  • Chih-Yuan Lin
  • Chung-Yi Li
  • Chien-Sung Tsai

DOI:

https://doi.org/10.1532/HSF98.20091067

Abstract

Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation, with an incidence of 0.8% to 20% in heart transplant (HTx) recipients, and standard treatment may be too toxic in some cases. Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies and has been demonstrated effective in combination with chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone). Cardiotoxicity with CHOP remains a major concern for treating HTx recipients with PTLD, however. We present a case of an HTx recipient with sick sinus syndrome and PTLD who was successfully treated with rituximab alone, avoiding the cardiotoxicity of CHOP. The cardiotoxicity induced by CHOP should be kept in mind in HTx recipients with PTLD, especially when there is an existing heart problem in such recipients. Monotherapy with rituximab can be considered a safe choice.

References

Coiffier B, Haioun C, Ketterer N, et al. 1998. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicentre phase II study. Blood 92:1927-32.nCoiffier B, Lepage E, Briere J, et al. 2002. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346:235-42.nGao SZ, Chaparro SV, Perlroth M, et al. 2003. Post-transplantation lymphoproliferative disease in heart and heart-lung transplant recipients: 30-year experience at Stanford University. J Heart Lung Transplant 22:505-14.nGharib MI, Burnett AK. 2002. Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis. Eur J Heart Fail 4:235-42.nHjalmarson A, Waagstein F. 1994. The role of beta-blockers in the treatment of cardiomyopathy and ischaemic heart failure. Drugs 47(Suppl 4):31-40.nIgarashi T, Itoh K, Kobayashi Y, et al. 2002. Phase II and pharmacokinetic study of rituximab with eight weekly infusions in relapsed aggressive B-cell non-Hodgkin's lymphoma (B-NHL) [abstract]. Proc Am Soc Clin Oncol 21:286a. Abstract no. 1142.nLu P. 2005. Monitoring cardiac function in patients receiving doxorubicin. Semin Nucl Med 35:197-201.nOertel SH, Verschuuren E, Reinke P, et al. 2005. Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant 5:2901-6.nRahman AM, Yusuf SW, Ewer MS. 2007. Anthracycline-induced cardiotoxicity and the cardiac-sparing effect of liposomal formulation. Int J Nanomedicine 2:567-83.nSafra T. 2003. Cardiac safety of liposomal anthracyclines. Oncologist 8(suppl 2):17-24.nSchimmel KJ, Richel DJ, van den Brink RB, et al. 2004. Cardiotoxicity of cytotoxic drugs. Cancer Treat Rev 30:181-91.nTakemura G, Fujiwara H. 2007. Doxorubicin-induced cardiomyopathy from the cardiotoxic mechanisms to management. Prog Cardiovasc Dis 49:330-52.nWallace KB. 2007. Adriamycin-induced interference with cardiac mitochondrial calcium homeostasis. Cardiovasc Toxicol 7:101-7.n

Published

2009-10-15

How to Cite

Yang, H.-Y., Ke, H.-Y., Hong, G.-J., Tsai, Y.-T., Lin, C.-Y., Li, C.-Y., & Tsai, C.-S. (2009). Monotherapy with Anti-CD20 Monoclonal Antibody in a Heart Transplant Recipient with Sick Sinus Syndrome and Posttransplantation Lymphoproliferative Disorder: A Case Report. The Heart Surgery Forum, 12(5), E300-E302. https://doi.org/10.1532/HSF98.20091067

Issue

Section

Article