Rituxan to prevent post transplant lymphocyte proliferation

Post-transplant lymphoproliferative disease (PTLD) remains a major complication after solid organ and allogeneic stem cell transplantation. It usually is caused by growth of lymphocytes infected with Epstein-Barr virus (EBV) in patients whose immune system is suppressed after transplantation to prevent rejection. Following titers and an individualized treatment plan including decreased immunosuppression and other agents should be chosen based on the severity and extent of disease.

There are different kinds of PTLD.  Rituxan appears to have some role in the management of this condition. Several studies show that it reduces both the EBV titers and severity of PTLD. It can be given by itself of with low dose chemotherapy.

Some physicians advocte following the EBV titers and treating when they rise.  The strategy of following titers and giving prophylactic Rituxan has not been formally studied.  Most published studies have dealt with treating patients who already have PTLD.

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