Post-transplant lymphoproliferative disorder after solid-organ transplant in children

Absalon, Michael J.; Khoury, Ruby; Phillips, Christine L

doi:10.1053/j.sempedsurg.2017.07.002

Cited by 28 publications

(36 citation statements)

References 125 publications

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“…In the rare event that PTLD is localized and not responsive to RI or rituximab, local treatment measures such as surgery or radiotherapy can be considered. Complete surgical resection is generally sought when there is a low chance for surgeryrelated morbidity, or when debulking is thought beneficial for rapid improvement of severe or life-threatening complications from a developing lymphomatous mass [46]. Radiotherapy and more intensive chemotherapy with anthracyclines and other agents are not considered front-line therapy for EBV-positive B-cell PTLD, and these agents are restricted to patients with refractory or recurrent disease, T-cell lymphomas or Hodgkin-like PTLD or central nervous system PTLD [1].…”

Section: Discussionmentioning

confidence: 99%

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

et al. 2021

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(1) Background: Post-transplant lymphoproliferative disease (PTLD) is a significant complication of solid organ transplantation (SOT). However, there is lack of consensus in PTLD management. Our aim was to establish a present benchmark for comparison between international centers and between various organ transplant systems and modalities; (2) Methods: A cross-sectional questionnaire of relevant PTLD practices in pediatric transplantation was sent to multidisciplinary teams from 17 European center members of ERN TransplantChild to evaluate the centers’ approach strategies for diagnosis and treatment and how current practices impact a cross-sectional series of PTLD cases; (3) Results: A total of 34 SOT programs from 13 European centers participated. The decision to start preemptive treatment and its guidance was based on both EBV viremia monitoring plus additional laboratory methods and clinical assessment (61%). Among treatment modalities the most common initial practice at diagnosis was to reduce the immunosuppression (61%). A total of 126 PTLD cases were reported during the period 2012–2016. According to their histopathological classification, monomorphic lesions were the most frequent (46%). Graft rejection after PTLD remission was 33%. Of the total cases diagnosed with PTLD, 88% survived; (4) Conclusions: There is still no consensus on prevention and treatment of PTLD, which implies the need to generate evidence. This might successively allow the development of clinical guidelines.

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Section: Discussionmentioning

confidence: 99%

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

et al. 2021

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“…As in other solid organ recipients, first‐line treatment of PTLD is restoration of T‐cell defenses by reducing immunosuppression . Response typically occurs in 2‐4 weeks, most often in early or polymorphic lesions . This reliance on immunosuppression reduction rather than complete cessation, which is possible in PTLD after liver transplantation, has virtually ensured that all intestinal transplant recipients are also treated with rituximab (chimeric anti‐CD20 monoclonal antibody) to eliminate B cells, and IVIG to passively boost anti‐EBV immunity.…”

Section: Ptld Managementmentioning

confidence: 99%

“…Solitary lesions affecting the intestinal allograft can be resected locally. For refractory disease, allograft enterectomy can be life‐saving if the liver or stomach has not been transplanted with the intestine . While many centers use antiviral drugs for EBV‐positive PTLD, their efficacy has not been confirmed in large prospective trials .…”

Section: Ptld Managementmentioning

confidence: 99%

Post‐transplant lymphoproliferative disorder in pediatric intestinal transplant recipients: A literature review

Stanley

Friehling

Ranganathan

et al. 2018

Pediatric Transplantation

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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.

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“…Other viral infections that may increase the risk of PTLD are cytomegalovirus, hepatitis C virus, and human herpesvirus 8 infection. The type, duration, and intensity of immunosuppressive therapy may be among the predisposing factors (6,7).…”

Section: Risk Factors For Development Of Ptld In Childrenmentioning

confidence: 99%

Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective

Marie¹,

Navallas²,

Navarro³

et al. 2020

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Posttransplant lymphoproliferative disorder (PTLD) is the most common malignancy that can occur after organ transplant in children. PTLD arises because the patient's immune system has been suppressed to protect the graft and may fail to provide an adequate immune check for transformed malignant or premalignant lymphocytes. PTLD risk factors and pathogenesis are not completely understood; however, Epstein-Barr virus is identified in many patients with PTLD and may contribute to its evolution. PTLD is a clinical challenge because the biologic behavior and clinical manifestations are diverse, and there is no standardized treatment. Treatment options include reduction of immunosuppression therapy, chemotherapy, radiation therapy, and surgical resection of localized lesions, depending on factors including the type and extent of disease, whether the patient has positive test results for the Epstein-Barr virus, and patient comorbidities. A multidisciplinary approach is essential for the appropriate management of PTLD. Diagnostic imaging modalities such as radiography, US, CT, MRI, and PET are essential in diagnosis, assessment of therapeutic response, and monitoring of this heterogeneous disease entity. When imaging findings are suggestive of PTLD, prompt tissue biopsy to identify the PTLD subtype is essential for appropriate treatment. It is important to know the proper indications and limitations of different diagnostic imaging techniques in the management of PTLD. In addition, familiarity with the imaging features of PTLD and its mimics narrows the differential diagnosis and may facilitate decision making about patient treatment. ©

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Post-transplant lymphoproliferative disorder after solid-organ transplant in children

Cited by 28 publications

References 125 publications

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

Post‐transplant lymphoproliferative disorder in pediatric intestinal transplant recipients: A literature review

Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective

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