Anti-CD20 monoclonal antibody (Rituximab) and cidofovir as successful treatment of an EBV-associated lymphoma with CNS involvement

Background. Epstein-Barr virus(EBV)-associated posttransplant lymphoprolife rative disease (PTLD) is a serious complication after allogeneic hematopoie tic stem cell transplantation (HSCT). Especially in cases with involvement of the central nervous system (CNS) treatment is difficult because the effi cacy of most chemotherapeutic agents as well as EBV-specific cytotoxic dono r T cells in liquor is uncertain. In the last years the anti-CD20 monoclona l antibody Rituximab was intensively investigated in the treatment of EBV-P TLD. However, only 8 patients with B-cell lymphoma and CNS involvement trea ted with Rituximab were reported. Case Report: A 24-year-old female patient with acute T-lymphoblastic leukemia in second complete remission had recei ved allogeneic, unrelated, T-cell depleted HSCT. 10 months later an EBV-ass ociated PTLD was diagnosed. Beside peripheral lymphomas and B symptoms the patient showed neurological symptoms. Examination of the cerebrospinal flui d (CSF) revealed a meningeosis lymphoblastica caused by the EBV lymphoma. T reatment with Rituximab and the antiviral drug Cidofovir led to complete re mission with regression of the peripheral lymphomas and disappearance of th e neurological symptoms. In addition, the PCR control on EBV DNA became neg ative in the plasma as well as in CSF Conclusion: The combination of Rituxi mab and Cidofovir appears as an interesting alternative treatment in patien ts with EBV-associated PTLD and CNS involvement.