Calcineurin Inhibitor-free Graft-Versus-Host Disease Prophylaxis With Sirolimus and Mycophenolate Mofetil in a Second Allogeneic Stem Cell Transplantation for Engraftment Failure and Rituximab-refractory Epstein-Barr Virus–induced Posttransplant Lymphoproliferative Disease

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Posttransplant lymphoproliferative disease (PTLD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. We describe here the case of a boy with history of induction failure of a T-cell acute lymphoblastic leukemia, who presented a life-threatening situation of nonengraftment and rituximab-refractory PTLD after the first hematopoietic stem cell transplantation. We decided to use an unusual strategy of combining a nonmyeloablative conditioning (fludarabine and cyclophosphamide) with a calcineurin inhibitor-free GvHD prophylaxis (sirolimus and mycophenolate mofetil). This strategy had permitted the control of an Epstein-Barr virus PLTD in umbilical cord blood transplantation without further reactivation.

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