SUCCESSFUL TREATMENT OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER WITH INTERFERON-ALPHA AND INTRAVENOUS IMMUNOGLOBULIN

We report on the use of interferon-alpha (INF-a) and high-dose non-spe cific intravenous immunoglobulin (IVIg) in 2 patients (a 60-yr-old fem ale and a 65-yr-old male) who developed post-transplant lymphoprolifer ative disorder (PTLD) 2 and 8 months after heart and liver transplanta tion, respectively. Both patients had received immunosuppression with ATG, CsA, azathioprine, and prednisone. The first patient did not rece ive additional immunosuppression with biological agents. The second pa tient developed 3 steroid-resistant acute rejection episodes requiring OKT3 (cumulative dose 100 mg) and ATG (cumulative dose 3450 mg). The first patient presented with nodules involving the liver, spleen, lung s and nasophar, ynx. The second patient presented with subcutaneous an d liver nodules, as well as pert-portal and para-aortic lymphadenopath ies. The histological diagnosis was diffuse B-cell PTLD in both patien ts. Despite reduction of immunosuppression, a progression of lesions w as observed in both patients over 5 months and 2 months, respectively. The first patient received INF-alpha (2 x 10(6) IU, s.c. 3 times/wk) and IVIg (0.5 g/kg i.v. every 15 d) for. 4 months, while the second pa tient received the same therapy for 12 and 7 months, respectively. Com plete disappearance of all lesions was observed after 3 months of ther apy in the first patient and after 7 months of therapy in the second p atient, as assessed by CT scan. PTLD remains in remission 47 and 33 mo nths after therapy, respectively. Our preliminary results suggest that the combination of INF-alpha and IVIg can be an effective therapy for PTLD which does not respond to reduction of immunosuppression.