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Treatment dilemma for survivors of rituximab-induced bowel perforation in the setting of post-transplant lymphoproliferative disorder
  1. Brianne J Sullivan1,
  2. Grace J Kim1 and
  3. Gabriel Sara2
  1. 1 Department of Surgery, Mount Sinai Health System, New York, New York, USA
  2. 2 Department of Oncology, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Dr Brianne J Sullivan, brianne.sullivan{at}


Post-transplant lymphoproliferative disorder (PTLD) is a recognised complication of solid and haematopoietic stem cell transplant. It consists of a heterogeneous group of lymphoid neoplasms that arises secondary to post-transplant immunosuppression. Although there is no definite standard of care for the optimal treatment for PTLD, rituximab, a monoclonal antibody, with and/or without chemotherapy (usually CHOP=cytoxan, doxorubicin, vincristine, prednisone) has become a routine part of the treatment of any CD20 (+) PTLD, with response rates similar to chemotherapy with decreased toxicity. A rare and often lethal, complication of rituximab therapy for PTLD is bowel perforation secondary to tumour lysis of lymphoma involving the intestine. A small number of cases of bowel perforation have been reported, with very few documented survivors. The risk for recurrent perforation in the setting of ongoing rituximab treatment is unknown. There is sparse data supporting how to best treat the survivors.

  • general surgery
  • unwanted effects / adverse reactions
  • pharmacology and therapeutics
  • oncology
  • malignant disease and immunosuppression

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  • Contributors BJS, GJK and GS all contributed towards the analysis and acquisition of data and the writing and editing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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