Post-transplant lymphoproliferative disorders

AK Singavi, AM Harrington, TS Fenske - Non-Hodgkin Lymphoma …, 2015 - Springer
AK Singavi, AM Harrington, TS Fenske
Non-Hodgkin Lymphoma: Pathology, Imaging, and Current Therapy, 2015Springer
Post-transplant lymphoproliferative disorders (PTLD) are a serious complication after solid
organ or allogeneic hematopoietic stem cell transplantation and include a range of diseases
from benign proliferations to malignant lymphomas. Risk factors for developing PTLD
include Epstein-Barr virus (EBV) infection, recipient age, transplanted organ, type of
immunosuppression, and genetics. Uncontrolled proliferation of EBV-infected B cells is
implicated in EBV-positive PTLD, whereas the pathogenesis of EBV-negative PTLD may be …
Abstract
Post-transplant lymphoproliferative disorders (PTLD) are a serious complication after solid organ or allogeneic hematopoietic stem cell transplantation and include a range of diseases from benign proliferations to malignant lymphomas. Risk factors for developing PTLD include Epstein-Barr virus (EBV) infection, recipient age, transplanted organ, type of immunosuppression, and genetics. Uncontrolled proliferation of EBV-infected B cells is implicated in EBV-positive PTLD, whereas the pathogenesis of EBV-negative PTLD may be similar to non-Hodgkin’s lymphoma in the general population. The World Health Organization (WHO) classifies PTLD into four categories: early lesions, polymorphic PTLD, monomorphic PTLD, and classical Hodgkin’s lymphoma (cHL). Treatment is aimed at cure of PTLD, while maintaining transplanted organ function. However, there are no established guidelines for the treatment of PTLD. Immune suppression reduction (ISR) is the first line of treatment in most cases, with more recent data suggesting early use of rituximab. In more aggressive forms of PTLD, upfront chemotherapy may offer a better and more durable response. Sequential therapy using rituximab followed by chemotherapy has demonstrated promising results and may establish a standard of care. Novel therapies including anti-viral agents, adoptive immunotherapy, and monoclonal antibodies targeting cytokines require further study in the prevention and treatment of PTLD.
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