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Core Messages Posttransplant lymphoproliferative disorders (PTLDs) straddle the disciplines of immunology, infection, and malignancy. The study of PTLD could lead to advances that have ramifications beyond transplantation. Early observations revealed that lightening of immunosuppression could lead to regression in some cases, eliminating the hopelessness of the word “lymphoma...
Core Messages Cases of cancer started appearing soon after introduction of chronic immunosuppression in organ transplant recipients Posttransplant lymphoproliferative disorders (PTLD) initially presented with varied features but a pathophysiologic paradigm was developed The linkage of PTLD to EBV was initially made serendipitously but then confirmed through several...
Core Messages Several different types of risk factors (host, infectious, transplant immunosuppression) are associated with posttransplant lymphoproliferative disorders (PTLD) development Epstein—Barr virus (EBV) infection is the single most important risk factor PTLD is a significant cause of earlier graft loss and added mortalit
Core Messages Epstein—Barr virus (EBV) hijacks the normal B cell differentiation process to access, and persists in the memory B cell compartment in healthy individuals. Infection of bystander B cells or failure of EBV-infected B cells to successfully transit through the B cell differentiation process could result in EBV+ B cell lymphomas in immunosuppressed individuals. ...
Core Messages Epstein—Barr virus (EBV) viral load (VL) assessment in peripheral blood represents a potentially powerful tool for surveillance as part of pre-emptive programs for posttransplant lymphoproliferative disorders (PTLD) prevention, for PTLD and EBV disease diagnosis in symptomatic patients, to monitor response to PTLD therapy and predict relapse, for safety monitoring in clinical...
Core Messages The major risk factor for posttransplant lymphoproliferative disorder (PTLD) is primary infection after transplantation The presenting signs and symptoms of PTLD are non-specific Epstein—Barr virus (EBV) serology is of limited value in the diagnosis of PTLD EBV load by itself has poor specificity for the diagnosis of PTLD Histopathologic...
Core Messages The posttransplant lymphoproliferative disorders (PTLD) are a spectrum of lymphoid and plasmacytic proliferations occurring in the posttransplant setting that are frequently, but not always, associated with the Epstein—Barr virus (EBV). Classification of PTLD into four major categories is performed using the 2008 WHO classification. Early type PTLD are non-destructive...
Core Messages Poor prognostic factors in the traditional non-Hodgkin's lymphomas (NHL), such as poor performance status, multifocal disease, and increased age, are also poor prognostic factors in posttransplant lymphoproliferative disorders (PTLD). Rituximab has proven efficacy in CD-20 positive PTLD and has altered the management and prognosis of this disease. ...
Core Messages No therapies are based on data from randomized clinical trials Current outcomes are suboptimal, both in adults and children Death is most common in the first year after diagnosis Success of therapy must include evaluation of allograft outcomes Several new therapies have emerged over the last decade including monoclonal antibody...
Core Messages Increasing attention is focused on the prevention of EBV disease and PTLD. A variety of potential approaches to the prevention of EBV disease and PTLD are currently under consideration including chemoprophylaxis using antiviral therapies, immunoprophylaxis (including adoptive immunotherapy), and viral load monitoring to inform pre emptive strategies. ...
Core Messages Incidence of Posttransplant lymphoproliferative disorders (PTLD) in kidney transplant recipients is relatively low: 0.4% at 1 year, 1.2% at 5 years, and 1.6% after 10 years. Risk factors of PTLD in kidney transplant recipients are principally EBV seronegativity and high level of immunosuppression. Clinical presentation is heterogeneous, but PTLD could...
Core Messages The incidence, morbidity, and mortality of PTLD in liver and intestine transplantations have significantly decreased over time. Incidence of PTLD in pediatric liver transplantation is currently 2–3%, and is approaching the 1–2% rate of PTLD seen after adult liver transplantation. Improvements in immunosuppression, EBV monitoring, pre emptive therapy,...
Core Messages The incidence of PTLD after heart and lung transplantation is higher than for all other types of solid organ transplantation other than intestinal The heart is almost never an involved organ; by contrast, lung involvement by PTLD is very common in heart, lung, and heart-lung recipients Clinical presentation of PTLD is highly variable and may mimic...
Core Messages Posttransplant lymphoproliferative disorders (PTLD) following hematopoietic stem cell transplantation (HSCT) is nearly 100% associated with EBV and occurs 3–6 months posttransplant. T cell depletion (TCD) of the hematopoietic stem cell graft (ex vivo or in vivo) is the strongest risk factor for developing PTLD. Anything that stimulates B cell proliferation and/or...
The preceding chapters of this book emphasize how much has been learnt about PTLD in the past few decades. Yet, so much still remains to be learned. Listed below are some of the unanswered questions regarding PTLD. Each of these areas is ripe for future research and gaining new knowledge.
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