Two patients with diabetic nephropathy were diagnosed with primary central nervous system posttransplant Epstein-Barr-virusassociated\r\nlymphoproliferative disorder (PTLD) 3 years after renal transplantation. The histological diagnoses of the isolated brain\r\ntumors were diffuse large B-cell lymphoma and plasmacytoma. Considerable co-morbidity precluded intensive chemotherapy.\r\nThe first patient with lymphoid CD20+ PTLD had a partial resection of her tumor performed. She was treated with 4 weekly\r\ndoses of rituximab, ganciclovir and prednisolone; the posttransplant immune suppression (tacrolimus) was reduced. After 4 weeks\r\nof treatment a magnetic resonance imaging (MRI) demonstrated complete regression of the CNS lesion. The patient continues\r\nto receive rituximab (every second month), valgangciclovir and low-dose prednisolone. Twenty-two months after initiation of\r\ntherapy, she is still in complete remission. The second patient was only treated with craniospinal irradiation involving the medulla\r\nto the second cervical vertebra and valgangciclovir. Moreover, the posttransplant immune suppression was reduced. A new MRI\r\ntwo months after initiation of therapy showed a complete regression of the lesions in the CNS; this was again demonstrated by\r\na MRI after 19 months. These 2 cases illustrate interesting alternative treatments of PTLD. To our knowledge, an EBV-associated\r\nPTLD of plasmacytic origin isolated to the CNS has never been described before.
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