Summary:Epstein-Barr virus-associated lymphoproliferative disorders have been frequently reported as a complication of solid organ and allogeneic bone marrow transplantation. Their occurrence is rare after autologous bone marrow transplantation (BMT) with only five published reports in the literature. We report two cases of posttransplant lymphoproliferative disorder occurring after autologous BMT for Hodgkin's disease and non-Hodgkin's lymphoma. Post-transplant lymphoproliferative disorders can occur after autologous BMT and should be included in the differential diagnosis of patients with persistent fever, adenopathy or pulmonary infiltrates. Keywords: PTLD; EBV; BMT; lymphoproliferation Post-transplant lymphoproliferative disorders (PTLD) are a well recognized complication of solid organ transplantation and are due to an unrestricted proliferation of Epstein-Barr virus (EBV)-infected lymphocytes occurring with immunosuppression.1,2 The majority of PTLD are of B cell origin; however, cases of T cell PTLD and Hodgkin's disease have been reported. [2][3][4] Pathologically, the lymphoproliferation encompasses a spectrum ranging from plasma cell hyperplasia and polymorphic B cell hyperplasia (similar to infectious mononucleosis), to monomorphic infiltrates indistinguishable from malignant lymphoma. 2,5,6 The risk for developing PTLD after solid organ transplantation is increased 20-to 150-fold compared to the incidence of lymphoma in the general population. The risk is greatest within the first year after transplant. [7][8][9] PTLD have been reported after allogeneic bone marrow transplantation (BMT) with an increased incidence after T cell depletion. 10,11 In contrast to the experience with PTLD after allogeneic BMT, PTLD after autologous BMT is infrequent.12-15 We present two patients who developed PTLD after autologous BMT.Correspondence: Dr RJ Hauke, Department of Internal Medicine, University of Nebraska Medical Center, 600 S 42nd Street, Omaha NE 68198-8065, USA Received 30 September 1997; accepted 27 January 1998 Case reports Patient 1A 27-year-old male with stage IIA nodular sclerosing Hodgkin's disease relapsed after treatment with doxorubicin, bleomycin, vincristine and dacarbazine. He received two cycles of mechlorethamine, vincristine, procarbazine and prednisone (MOPP) and then received high-dose cyclophosphamide, carmustine and etoposide followed by autologous BMT. Following transplant, 4500 cGy consolidation radiation therapy was given to the mediastinum.On day +87, he developed dyspnea and bilateral pulmonary infiltrates. Bronchoalveolar lavage was nondiagnostic. Low grade fevers and dyspnea persisted after empiric antibiotic therapy.After referral to our institution, a video-assisted thoracoscopy was performed. Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) pneumonitis were diagnosed.Sulfamethoxazole/trimethroprim, ganciclovir (2.5 mg/kg every 8 h i.v.), immune globulin and prednisone were administered with prompt clinical improvement. Recurrent pneumothoraces required pleural stri...

Hodgkin's disease occurring in the post-transplantation period should probably be treated like Hodgkin's disease in non-immunosuppressed patients. Prolonged disease-free survival is possible and function of the transplanted organ can be preserved.

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e14564 Background: In a phase I dose finding study, the maximum tolerated dose of sorafenib was determined to be 400 mg bid. In subsequent practice, these doses of sorafenib have been associated with minimal or reversible toxicity, which presented an opportunity to explore more intensive dosing. A single institution trial of 44 patients demonstrated complete responses in 26% and partial responses in 36%. 93% of patients were able to be dose escalated. The objective of our study was to confirm these findings. The primary endpoints for this study were safety, feasibility, and toxicity. Secondary endpoints included overall response rate (ORR) and progression- free survival (PFS). Methods: Patients with treatment-naïve metastatic renal cell with clear cell histology were enrolled at Stanford University and the University of Nebraska Medical Center. Cycles consisted of 28 days. Dose limiting toxicity (DLT) was defined as grade 3/ 4 toxicity. Patients received sorafenib 400mg bid for 28 days. If no DLT's were reported after the first cycle, patients were dose escalated to sorafenib 600 mg bid for cycle 2. Patients without DLTs at the end of the second cycle were dose escalated to the highest dose, sorafenib 800 mg bid. Patients continued on therapy until progression or unacceptable toxicity. Results: To date, thirteen patients have been treated. Median age was 63 (47–84) years. The majority (84%) were men. Ten patients had nephrectomy prior to trial initiation. Sites of metastases included lung, nodes, liver, adrenal glands, and bone. Dose escalation was possible in 70% of the patients. Median number of cycles was 7 (3–12). Hand-foot syndrome (skin toxicity) limited escalation in the other 30% of patients. One pathologic complete response was obtained after a patient underwent metastectomy of adrenal gland after 4 cycles. One patient achieved a partial response and seven experienced disease stabilization. Conclusions: This dose-escalation trial is ongoing. Dose escalation has been feasible in 70% of patients. The main toxicity limiting escalation was hand-foot syndrome. Thus far, dose escalation did not result in an increased number of responses as compared to the standard 800mg/d dosing. PFS data will be presented as data matures. [Table: see text]

e16154 Background: Treatment for patients with node positive prostate cancer remains challenging. With hormonal ablation therapy (HAT), conventional radiation doses to the lymph nodes produces few cures or long-term remissions, likely due to suboptimal doses and/or fields of radiation. Docetaxel has radiosensitizing properties. We conducted a phase I study combining HAT with EF-IMRT and concurrent docetaxel in men with biopsy-proven node positive prostate cancer. Methods: Eligible patients had biopsy proven N1M0 disease and adequate hematologic and hepatic function. All subjects received neoadjuvant HAT (bicalutamide 50 mg/d with an LHRH agonist) for at least 2 months but less than 13 months prior to EF-IMRT and continued for 2 years after completion of radiation (bicalutamide discontinued at the end of radiation). EF-IMRT target doses: prostate 81.0 Gy/45 fractions; intraprostatic target 81.0 - 84.6 Gy/45 fractions; pathologically involved lymph node 72 Gy/43 fractions; pelvic lymph nodes 54.0 Gy to 70.2 Gy/43 fractions. Ultrasound targeting and a water filled rectal catheter balloon were used daily to minimize movement and locate the prostate. Weekly docetaxel was administered during radiation at 5, 10 or 17 mg/m2. The primary endpoint was determining grade III/IV toxicity. Results: Nine patients have been treated. No grade III/IV toxicities occurred within the defined observation period. All subjects received their prescribed radiation and chemotherapy doses. One patient developed an anal fissure and one patient had tachyarrhythmias about 6 months after radiation. Seven of 9 patients are now beyond the 2 year post-radiation period; 4 patients remain in remission; one patient developed primary lung cancer; another was lost to follow up at 1 year post-radiation and 3 had relapsed disease within the 2 year post-radiation window. Conclusions: The addition of weekly docetaxel to EF-IMRT along with HAT is well tolerated in patients with node positive prostate cancer. Phase II studies are warranted based on these results. [Table: see text]