Case study: Successful full-course chemotherapy administration in a liver transplant recipient diagnosed with central nervous system World Health Organization Grade 2 IDH mutant/1p-19q co-deleted oligodendroglioma.

Background: Current World Health Organization (WHO) 2021 classification of adult-type diffuse gliomas includes three main diagnostic entities with different prognosis and treatment algorithm: glioblastoma IDH wild-type, astrocytoma IDH mutant, and oligodendroglioma IDH mutant/1p-19q co-deleted. For IDH mutant gliomas, it is well known that administering postoperative chemo-radiation based on risk factors such as age, extent of resection, and WHO grading significantly improves disease control and overall survival. However, whether the use of chemotherapy may be considered safe in special populations such as orthotopic liver transplant recipients (TRs) is still not fully understood. Case summary: Here, we report the case of a 56-year-old patient diagnosed with central nervous system WHO grade 2 oligodendroglioma IDH mutant/1p-19q co-deleted and medical history of orthotopic liver transplantation for HCV-related cirrhosis, subsequent HCV infection relapse and on therapy with immunosuppressive agents (tacrolimus plus everolimus). After radiation therapy, benefits and risks of chemotherapy were carefully assessed in terms of drug-to-drug interactions, additive immune-suppression, potential hepatic toxicity, and possibility of organ rejection. The patient successfully received a full course of standard-schedule temozolomide for 12 cycles, with no adverse events to be reported. Notably, imaging findings consistent with treatment-related changes were observed during chemotherapy cycles, managed with appropriate diagnostic workflow and no treatment interruption. Conclusion: This case study described for the first time safe administration of temozolomide-based chemotherapy in an orthotopic TR, sharing potential insights for best managing such a rare clinical scenario.