One of the most severe complications after organ transplant is post-transplant lymphoproliferative disorder (PTLD). This condition occurs due to the use of immunosuppressants during and after transplant surgery. It is characterized by an uncontrolled proliferation of B cell lymphocytes, causing the development of lesions, which can become malignant if the B cells undergo mutations. Symptoms can resemble infectious mononucleosis, including fatigue, weight loss, fever, night sweats, and pain related to developing tumors.
Treatment for PTLD generally involves the reduction of immunosuppressing agents and may include rituximab. However, a reduction in immunosuppression can lead to transplant rejection, graft-versus-host disease, cancer relapse, or other diseases. As such, the optimal treatment remains unknown.
In a case series published in The Journal of Pediatric Hematology/Oncology, clinicians from the Mayo Clinic in Rochester, Minnesota, presented 3 pediatric patients with plasmacytic PTLD.
Per the article, “Two patients received a standard rituximab-based approach and relapsed, prompting additional chemotherapy.” However, their third patient received the novel combination of bortezomib, dexamethasone, and daratumumab. “This regimen was safe, well-tolerated, and resulted in a 2-year remission,” reported the clinicians.
Given this is a single case, extreme caution must be given when interpreting the results. However, larger, sufficiently powered studies should be undertaken to determine the efficacy of this therapeutic trio in the pediatric immunosuppressed transplant patient population with some scientific certainty.