TLJ 2.0 - WS03: Cancer and immunosuppression in solid organ transplant recipients (SOT) - part 2

WS03 - Question 2

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Question Title

* 1. Your 25-year old kidney transplant patient developed post-transplant lymphoma* which was brought into remission with R-CHOP**.

During PTLD therapy, his maintenance immunosuppression was kept low (prednisolone 5 mg/day + everolimus (trough levels 3-5 ng/mL)).
After completing treatment, kidney function remained stable without proteinuria, but he developed de novo donor specific antibodies (anti-DQ, MFI 1500).
Kidney biopsy showed no signs of T-cell or antibody-mediated rejection.

*diffuse large B-cell lymphoma, type T-cell/histiocyte rich B cell lymphoma, EBV negative
** rituximab monotherapy followed by 6 pulses R-CHOP ( rituximab + cyclofosfamide + adriamycine + vincristine + prednisolone).
Remission based on clinical examination and PET-CT.

What would you do with the maintenance immunosuppressive therapy?

Continue with the same therapy

Increase the target levels of everolimus

Add mycophenolate mofetil

Switch from everolimus to a calcineurin-inhibitor

Switch from everolimus to a calcineurin-inhibitor plus mycophenolate mofetil