Clinical and Pathological Review of Post Transplant Lymphoproliferative Disorders (original) (raw)
Related papers
Journal of Clinical Medicine
Post-transplant lymphoproliferative disease (PTLD) is a serious complication occurring as a consequence of immunosuppression in the setting of allogeneic hematopoietic stem cell transplantation (alloHSCT) or solid organ transplantation (SOT). The majority of PTLD arises from B-cells, and Epstein–Barr virus (EBV) infection is present in 60–80% of the cases, revealing the central role played by the latent infection in the pathogenesis of the disease. Therefore, EBV serological status is considered the most important risk factor associated with PTLDs, together with the depth of T-cell immunosuppression pre- and post-transplant. However, despite the advances in pathogenesis understanding and the introduction of novel treatment options, PTLD arising after alloHSCT remains a particularly challenging disease, and there is a need for consensus on how to treat rituximab-refractory cases. This review aims to explore the pathogenesis, risk factors, and treatment options of PTLD in the alloHSCT...
4 Posttransplant Lymphoproliferative Disorders Following Kidney Transplantation
2012
Posttransplant lymphoproliferative disorder (PTLD) is a rare but life threatening disorder following both solid organ and hematopoietic stem cell transplantation. The disorder is characterized by an uncontrolled proliferation of lymphocytes, caused by medication induced diminished immune surveillance. From a pathological point of view PTLD has a broad and heterogeneous spectrum of appearance, ranging from a benign condition to frank lymphoma. Although not required for diagnosis of PTLD, Epstein Barr virus (EBV) plays a major role in the pathogenesis of the majority of PTLDs. Currently the gold standard in diagnosis of PTLD remains biopsy with histopathologic examination to categorize every case according to the World Health Organization 2008 classification. Similar to its heterogeneous presentation treatment options are diverse and may include preventive, preemptive, curative and palliative approaches. However, the backbone of all PTLD therapies –except maybe for real palliationshou...
Transplant Infectious Disease, 2019
BackgroundPost‐transplant lymphoproliferative disorders (PTLD) are associated with significant morbidity and mortality following allogeneic hematopoietic cell transplant (alloHCT). Although most PTLD is EBV‐positive (EBVpos), EBV‐negative (EBVneg) PTLD is reported, yet its incidence and clinical impact remain largely undefined. Furthermore, factors at the time of transplant impacting survival following PTLD are not well described.MethodsBetween 2002 and 2014, 432 cases of PTLD following alloHCT were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). After exclusions, 267 cases (EBVpos = 222, 83%; EBVneg = 45, 17%) were analyzed.ResultsTwo hundred and eight patients (78%) received in vivo T‐cell depletion (TCD) with either anti‐thymocyte globulin (ATG) or alemtuzumab. Incidence of PTLD was highest using umbilical cord donors (UCB, 1.60%) and lowest using matched related donors (MRD, 0.40%). Clinical features and histology did not significantly dif...
Clinical Infectious Diseases, 2004
Posttransplantation lymphoproliferative disorders (PTLDs) have emerged as important causes of morbidity and mortality in solid organ transplant recipients. Epstein-Barr virus (EBV) plays a major pathophysiologic role in the development of many, if not most, of the highly diverse disease states, which span the spectrum from infection to malignancy, encompassed by the term "PTLD." Clinical presentation and biological behavior associated with PTLD are highly variable; patients experiencing primary EBV infection in the immediate posttransplantation period are most vulnerable. New insights into PTLD pathogenesis provide exciting opportunities for rational and targeted approaches to the diagnosis, prevention, and treatment of PTLD. This article highlights some of these developments and outlines unresolved and controversial issues in PTLD management.
How we diagnose and treat posttransplant lymphoproliferative disorders
Blood, 2015
Posttransplant lymphoproliferative disorder (PTLD) is a potentially fatal disorder arising after solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT). Iatrogenically impaired immune surveillance and Epstein-Barr virus (EBV) primary infection/reactivation are key factors in the pathogenesis. However, current knowledge on all aspects of PTLD is limited due to its rarity, morphologic heterogeneity, and the lack of prospective trials. Furthermore, the broad spectrum of underlying immune disorders and the type of graft represent important confounding factors. Despite these limitations, several reviews have been written aimed at offering a guide for pathologists and clinicians in diagnosing and treating PTLD. Rather than providing another classical review on PTLD, this “How I Treat” article, based on 2 case reports, focuses on specific challenges, different perspectives, and novel insights regarding the pathogenesis, diagnosis, and treatment of PTLD. These challenges ...
Clinical and Developmental Immunology, 2013
Posttransplant lymphoproliferative disorder (PTLD) is a potentially fatal disease that arises in 2%–10% of solid organ and hematopoietic stem cell transplants and is most frequently of B-cell origin. This very heterogeneous disorder ranges from benign lymphoproliferations to malignant lymphomas, and despite the clear association with Epstein-Barr Virus (EBV) infection, its etiology is still obscure. Although a number of risk factors have been identified (EBV serostatus, graft type, and immunosuppressive regimen), it is currently not possible to predict which transplant patient will eventually develop PTLD. Genetic studies have linked translocations (involvingC-MYC, IGH, BCL-2), various copy number variations, DNA mutations (PIM1, PAX5, C-MYC, RhoH/TTF), and polymorphisms in both the host (IFN-gamma, IL-10, TGF-beta, HLA) and the EBV genome to B-cell PTLD development. Furthermore, the tumor microenvironment seems to play an important role in the course of disease representing a local...