Researchers Report Progress in Treating PTLD in Kidney Transplant Recipients

PTLD, a form of cancer of the glands of the lymph system associated with the presence of the Epstein-Barr virus [EBV], occurs in one to two percent of kidney transplant recipients, with mortality ranging from 50 to 70 percent

While EBV is present in most humans, it poses special problems for transplant patients because the immunosuppressive drugs they have to take to keep from rejecting new organs weaken the immune system and create the perfect environment for EBV-infected B lymphocytes proliferate uncontrollably.

But Ohio State researchers reported in the journal Blood that they have had significant success treating PTLD using a two-part therapy that includes the use of the antiviral drug acyclovir along with gradual reductions in patients' immunosuppressive medications.

Drs. Pierluigi Porcu and Charles Eisenbeis reported that they used this therapy for 11 kidney transplant patients who developed PTLD eight to 94 months after transplant, developing diffuse large B-cell lymphomas.

Following treatment, they said all evidence of the disease disappeared in 10 of 11 patients, 9 of them remained free of the disease during a median follow-up of almost two and one-half years. Patients who recovered had stronger immune systems, measured by increases in the numbers of their T cells, suggesting the therapy stimulated the specific cells needed to destroy the lymphoma, the researchers said.

But Porcu said the therapy has some limitations, since kidney rejection occured in those patients with PTLD in the transplanted organ.

"Still, the survival results from a potentially fatal malignancy are striking and those patients losing the kidney graft should ultimately be eligible for a second transplant," he added.