Cyclophosphamide, Rituximab, and Either Prednisone or Methylprednisolone in Treating Patients With Lymphoproliferative Disease After Solid Organ Transplantation

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Histologically confirmed post-transplant lymphoproliferative disease (PTLD)
• •* Presents with 1 of the following:
• •* Fulminant PTLD (F-PTLD)
• •* Fever greater than 38°C
• •* Hypotensive (for age)
• •* Evidence of multiple organ involvement/failure, including at least 2 of the following:
• •* Marrow (including pancytopenia without detectable B-cell proliferation)
• •* Liver (coagulopathy, transaminitis, and/or hyperbilirubinemia)
• •* Lungs (interstitial pneumonitis with or without pleural effusions)
• •* Gastrointestinal tract hemorrhage
• •* Non-fulminant PTLD (NF-PTLD)
• •* Does not meet the above F-PTLD criteria
• •* Considered medically refractory to reduced immune suppression (50% or more reduction of immunosuppression) for at least 1 week
• •CD20 positive AND Epstein-Barr virus positive
• •Must have received prior solid organ transplantation
• •Must have residual disease after biopsy and/or surgery
• •No PTLD central nervous system (CNS) disease, defined as positive cytology and/or radiographic evidence
• •PATIENT CHARACTERISTICS:
• •Age
• •Under 31
• •Performance status
• •Not specified
• •Life expectancy
• •NF-PTLD patients:
• •* At least 8 weeks
• •Hematopoietic
• •See Disease Characteristics
• •Hepatic
• •See Disease Characteristics
• •Renal
• •Not specified
• •Pulmonary
• •See Disease Characteristics
• •Other
• •Not pregnant or nursing
• •Fertile patients must use effective contraception
• •HIV negative
• •PRIOR CONCURRENT THERAPY:
• •Biologic therapy
• •More than 1 month since prior rituximab
• •Chemotherapy
• •More than 4 weeks since prior chemotherapy and recovered
• •Endocrine therapy
• •Not specified
• •Radiotherapy
• •Not specified
• •Surgery
• •See Disease Characteristics