REMISSION OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDER AFTER INTERFERON-ALFA THERAPY

Posttransplant lymphoproliferative disorder (PTLD) is one of the major complications of immunosuppressive therapy. PTLD is strongly associat ed with the Epstein-Barr virus (EBV). It is believed that EBV-infected B cells proliferate in an unchecked manner due to suppression of cyto toxic T cells and elevation of B cell-promoting cytokines. There is no consensus on the treatment of PTLD other than reduction of immunosupp ressive therapy. We report a case of PTLD with monoclonal B cells conf ined to the lymph nodes. The patient did not initially respond to redu ction of immunosuppression, oral acyclovir, and intravenous immunoglob ulin injection. She subsequently responded when subcutaneous injection s of interferon alfa (5 million U) were given three times a week. The patient received a 3-mo course of interferon and remained in remission 12 mo after treatment. Her graft function was well maintained, and cy closporin A was restarted 2 mo after achieving remission. The clinical manifestations, risk factors, pathogenesis, and treatment of PTLD, as well as 12 previously reported cases of PTLD treated with interferon, were reviewed. On the basis of the results presented here, it appears that interferon alfa may be useful in treating PTLD and that there is a need for further clinical trials.