Long-term complete remission and immune tolerance after intensive chemotherapy for lymphoproliferative disorders complicating liver transplant

Background B cell lymphoproliferative disorders (LPD) and liver:rejection a re major lethal complications after hepatic transplantation. Reduction in i mmunosuppression is the treatment for the former, but is a risk factor for the latter. Methods. Here, we report three consecutive children with monoclonal LPD com plicating orthotopic liver transplantation. All of them were treated with b rief (<4 months) but intensive: chemotherapy, Results. These three patients have remained in complete remission for LPD f or 18 months to more than 3 years. Aggressive antimicrobial prophylaxis was successful in preventing life-threatening infections. The patient who rece ived the highest cumulative doses of chemotherapy may have also developed r elative immune tolerance to the allograft. Conclusions. High-dose-intensity chemotherapy may be effective in the treat ment of monoclonal LPD, as well as in the induction of immune tolerance for the prevention of allograft rejection and LPD recurrence.