Post-transplant lymphoproliferative disorders after lung transplantation: first-line treatment with rituximab may induce complete remission

: Background: Post‐transplant lymphoproliferative disorders (PTLD) are potentially lethal complications of solid organ transplantation. We, here, report on our experience with rituximab, an anti‐CD20 monoclonal antibody, as first‐line treatment for PTLD in six lung transplant recipients. Patients and methods: Two of the patients developed PTLD during the first year after transplantation, while four developed late‐onset PTLD. One patient presented with PTLD localized to the graft, one had unilateral cervical lymph nodes, and the others presented with multi‐organ involvement. All patients had diffuse large B‐cell lymphoma. Immunosuppressive therapy was reduced and rituximab was administered at a dose of 375 mg/m2/wk for 4 wk. Results: One patient did not respond to the first two courses of rituximab, received conventional chemotherapy, and achieved complete remission; four patients achieved complete remission after four courses with a median relapse‐free survival of 34 months (range: 14–55); and one patient did not respond and died. The diagnosis of complete remission was established by conventional imaging techniques combined to whole‐body positron emission tomography scan. Conclusions: We conclude that reduction in immunosuppression combined to first‐line treatment with rituximab may induce long‐term complete remission in lung transplant recipients presenting PTLD.