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Biomedical Papers of the Medical... Dec 2009Posttransplant lymphoproliferative disorder (PTLD) is increasingly recognized as a serious complication of solid organ transplantation in both children and adults.... (Review)
Review
BACKGROUND
Posttransplant lymphoproliferative disorder (PTLD) is increasingly recognized as a serious complication of solid organ transplantation in both children and adults. Factors associated with increased risk of PTLD include mismatch of recipient and donor EBV serologic status (seronegative recipient with seropositive donor), and intensive drug-induced immunosuppression.
METHODS AND RESULTS
We searched MEDLINE for articles published since 1970 to January 2009. Search terms included posttransplant lymphoproliferative disorder, immunosuppression, posttransplant malignancy, treatment, antiviral agents, rituximab, interferon alpha, chemotherapy, radiation, surgery. Studies in English of adult and pediatric populations after solid organ transplantation were selected and analyzed.
CONCLUSION
Screening of patients at risk and balancing the intensity of immunosuppression against the risk of allograft rejection could reduce the risk of developing PTLD. In patients who develop PTLD, the severity and extent of disease should be examined and an individualized treatment plan including immunosuppression reduction and other agents should accordingly be chosen.
Topics: Epstein-Barr Virus Infections; Humans; Immunosuppressive Agents; Lymphoproliferative Disorders; Transplantation
PubMed: 20208963
DOI: 10.5507/bp.2009.043 -
Anticancer Research Nov 2022This is a review of the therapeutic options for resistant/refractory post-transplant lymphoproliferative disorder (PTLD) in relation to Chimeric antigen receptor-T cell... (Review)
Review
This is a review of the therapeutic options for resistant/refractory post-transplant lymphoproliferative disorder (PTLD) in relation to Chimeric antigen receptor-T cell (CAR-T) therapy. Out of a number of possible future strategies for the treatment of PTLD, the following methods were implemented in real-world practice: anti-PD1 therapy with checkpoint inhibitor nivolumab, new anti-CD20 ofatumumab, brentuximab vedotin, and zanubrutinib. However, for all these innovative methods, only individual cases of successful treatment of rituximab-resistant Epstein-Barr Virus (EBV)-PTLD patients have been reported so far. CAR-T is an innovative method of treatment, based on genetic modification of receptors of T autologous lymphocytes, creating the "living drug". This therapy can be potent against resistant PTLD, which is a lymphoproliferation of B-lymphocytes. The published real-world data of 17 patients treated with CAR-T for PTLD indicate a success rate of 76.5%. There is development of innovative methods of treatment of resistant/refractory PTLD, with high rate of resolution after CAR-T therapy.
Topics: Humans; Herpesvirus 4, Human; Epstein-Barr Virus Infections; Receptors, Chimeric Antigen; Rituximab; Brentuximab Vedotin; Nivolumab; Lymphoproliferative Disorders
PubMed: 36288856
DOI: 10.21873/anticanres.16024 -
Seminars in Pediatric Surgery Aug 2017The post-transplant lymphoproliferative disorders (PTLD) are a diverse group of potentially life-threatening conditions affecting organ transplant recipients. PTLD... (Review)
Review
The post-transplant lymphoproliferative disorders (PTLD) are a diverse group of potentially life-threatening conditions affecting organ transplant recipients. PTLD arises in the setting of an attenuated host immunologic system that is manipulated to allow a foreign graft but then fails to provide adequate immune surveillance of transformed malignant or premalignant lymphocytes. The diversity of biological behavior and clinical presentation makes for a challenging clinical situation for those involved in the care of children with PTLD occurring after solid-organ transplantation. This review details a large transplant center's multidisciplinary approach to monitoring for PTLD and systematic approach to intervention, which has been essential for early recognition and successful treatment.
Topics: Child; Combined Modality Therapy; Humans; Lymphoproliferative Disorders; Organ Transplantation; Postoperative Complications; Risk Factors; Treatment Outcome
PubMed: 28964482
DOI: 10.1053/j.sempedsurg.2017.07.002 -
Internal Medicine (Tokyo, Japan) Jun 2019Lymphoproliferative disorders can occur in patients with autoimmune disorders who undergo long-term methotrexate therapy (MTX-LPD). Although the manifestations of... (Review)
Review
Lymphoproliferative disorders can occur in patients with autoimmune disorders who undergo long-term methotrexate therapy (MTX-LPD). Although the manifestations of MTX-LPD are diverse, little attention is paid to endobronchial involvement. We herein describe two patients with MTX-LPD who presented with parenchymal pulmonary tumors and endobronchial involvement of LPD; one had lymphomatoid gramulomatosis and the other LPD. The patients had no tumors adjacent to the endobronchial lesions. The endobronchial findings included multiple protruded mucosal lesions covered with white material, which was pathologically consistent with LPD. Recognition of the findings may help in making an earlier diagnosis of MTX-LPD in appropriate settings.
Topics: Adult; Antirheumatic Agents; Arthritis, Rheumatoid; Bronchial Diseases; Bronchoscopy; Female; Humans; Lymphoproliferative Disorders; Male; Methotrexate; Middle Aged; Tomography, X-Ray Computed
PubMed: 30713318
DOI: 10.2169/internalmedicine.2109-18 -
Pediatric Transplantation Aug 2018Intestinal transplantation is a successful treatment for children with intestinal failure, but has many potential complications. PTLD, a clinically and histologically... (Review)
Review
Intestinal transplantation is a successful treatment for children with intestinal failure, but has many potential complications. PTLD, a clinically and histologically diverse malignancy, occurs frequently after intestinal transplantation and can be fatal. The management of this disease is particularly challenging. The rejection-prone intestinal allograft requires high levels of immunosuppression, a precondition for PTLD. While EBV infection clearly plays a role in disease pathogenesis, the relatively naïve immune system of children is another likely contributor. As a result, pediatric intestine recipients have a higher risk of developing PTLD than other solid organ recipients. Other risk factors for disease development such as molecular and genomic changes that precipitate malignant transformation are not fully understood, especially among children. Studies on adults have started to describe the molecular pathogenesis of PTLD, but the genomic landscape of the malignancy remains largely undefined in pediatric intestinal transplant patients. In this review, we describe what is known about PTLD in pediatric patients after intestinal transplant and highlight current knowledge gaps to better direct future investigations in the pediatric population.
Topics: Humans; Intestines; Lymphoproliferative Disorders; Postoperative Complications
PubMed: 29745058
DOI: 10.1111/petr.13211 -
Pathobiology : Journal of... 2013Posttransplant lymphoproliferative disorder (PTLD) involves uncommon, severe complications following the transplantation of solid organs, bone marrow and stem cells.... (Review)
Review
Posttransplant lymphoproliferative disorder (PTLD) involves uncommon, severe complications following the transplantation of solid organs, bone marrow and stem cells. Despite comprising mainly lymphoid proliferations that are predominantly driven by lymphotropic Epstein-Barr virus (EBV) infections, PTLD often displays substantial morphologic heterogeneity that can pose diagnostic challenges. With the steady increase in transplantations accompanied by potent immunosuppressive therapy, it is important to heighten awareness of this entity among clinicians and pathologists. In comparison to systemic PTLD, cases that primarily manifest in the central nervous system (CNS) are reported to be more severe and to exhibit unique characteristics. So far, only isolated cases and small series have been reported describing CNS involvement in PTLD. In this article, we review the current knowledge, focusing on the histopathological features of primary CNS lymphoproliferative disorders following organ transplantation.
Topics: Brain; Diagnosis, Differential; Humans; Lymphoproliferative Disorders; Organ Transplantation
PubMed: 24013167
DOI: 10.1159/000347225 -
Seminars in Nuclear Medicine Jul 2021Post-transplant lymphoproliferative disorders (PTLD) are a spectrum of heterogeneous lymphoproliferative conditions that are serious and possibly fatal complications... (Review)
Review
Post-transplant lymphoproliferative disorders (PTLD) are a spectrum of heterogeneous lymphoproliferative conditions that are serious and possibly fatal complications after solid organ or allogenic hematopoietic stem cell transplantation. Most PTLD are attributed to Epstein-Barr virus reactivation in B-cells in the setting of immunosuppression after transplantation. Early diagnosis, accurate staging, and timely treatment are of vital importance to reduce morbidity and mortality. Given the often nonspecific clinical presentation and disease heterogeneity of PTLD, tissue biopsy and histopathological analysis are essential to establish diagnosis and most importantly, determine the subtype of PTLD, which guides treatment options. Advanced imaging modalities such as F-FDG PET/CT have played an increasingly important role and have shown high sensitivity and specificity in detection, staging, and assessing treatment response in multiple clinical studies over the last two decades. However, larger multicenter prospective validation is still needed to further establish the clinical utility of PET imaging in the management of PTLD. Significantly, new hybrid imaging modalities such as PET/MR may help reduce radiation exposure, which is especially important in pediatric transplant patients.
Topics: Child; Epstein-Barr Virus Infections; Fluorodeoxyglucose F18; Herpesvirus 4, Human; Humans; Lymphoproliferative Disorders; Multicenter Studies as Topic; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography
PubMed: 33455722
DOI: 10.1053/j.semnuclmed.2020.12.009 -
American Journal of Hematology Jul 2014
Topics: Aged; Epstein-Barr Virus Infections; Humans; Lymphoproliferative Disorders; Male
PubMed: 24729413
DOI: 10.1002/ajh.23739 -
Clinical Gastroenterology and... Jun 2021
Topics: Arthritis, Rheumatoid; Humans; Intestine, Small; Lymphoproliferative Disorders; Methotrexate
PubMed: 32205225
DOI: 10.1016/j.cgh.2020.03.037 -
Current Treatment Options in Oncology May 2018Post-transplant lymphoproliferative disorder (PTLD) is one of the most common neoplasms seen after solid organ and hematopoietic stem cell transplantation, and is... (Review)
Review
Post-transplant lymphoproliferative disorder (PTLD) is one of the most common neoplasms seen after solid organ and hematopoietic stem cell transplantation, and is associated with significant morbidity and mortality. The pathogenesis is related to post-transplant immunosuppression and EBV infection. Prevention of PTLD depends upon judicious use of immunosuppression and serial EBV monitoring. Preemptive therapy consists of reduction of immunosuppression, antiviral medications, and single-agent rituximab. There are no randomized phase III trials on PTLD treatment, so current management guidelines are largely based on recent phase II trials, single-institution retrospective studies, and expert opinion. Management of PTLD is dependent upon its subtypes. Early-type and polymorphic PTLD generally respond to reduction of immunosuppression and rituximab monotherapy, whereas monomorphic PTLD often requires additional concurrent or sequential use of chemotherapy. For rare subtypes of PTLD, standard-of-care guidelines for de novo lymphomas are recommended. Surgical resection or radiotherapy may be used as adjunctive therapy depending on the extent of disease. Non-chemotherapy options such as adoptive T cell therapy have shown promising efficacy and must be explored further. Despite progress in the last decade, overall survival rates continue to be low in published series. This review highlights the need for prospective randomized trials incorporating novel agents to improve outcomes in PTLD.
Topics: Combined Modality Therapy; Disease Management; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Lymphoma, B-Cell; Lymphoproliferative Disorders; Prevalence; Prognosis; Risk Factors; Symptom Assessment
PubMed: 29797086
DOI: 10.1007/s11864-018-0549-6