Management of post-transplant lymphoproliferative disorders

Br J Haematol. 2018 Aug;182(3):330-343. doi: 10.1111/bjh.15263. Epub 2018 May 9.

Abstract

The post-transplant lymphoproliferative disorders (PTLDs) are a heterogeneous group of neoplasms that are one of the most serious complications of bone marrow and solid organ transplants. Because these disorders are rare, there are no randomized trials from which to derive optimal treatment. Management can be challenging and must balance the goal of PTLD eradication with the risks of graft rejection, graft-versus-host disease, further delays in immune reconstitution and life-threatening infections, among others. This paper will provide a comprehensive review of PTLD following solid organ transplant and haematopoietic stem cell transplant with a focus on management. Included is a discussion of novel agents that are being studied in clinical trials and, when combined or sequenced with conventional therapy, have the potential to improve outcomes.

Keywords: Epstein-Barr virus; cellular therapies; lymphoproliferative disease; new drugs for lymphoma; transplantation.

Publication types

  • Review

MeSH terms

  • Epstein-Barr Virus Infections / complications
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects
  • Lymphoproliferative Disorders / diagnosis
  • Lymphoproliferative Disorders / etiology*
  • Lymphoproliferative Disorders / immunology
  • Lymphoproliferative Disorders / therapy
  • Organ Transplantation / adverse effects*
  • Prognosis
  • Risk Factors

Substances

  • Immunosuppressive Agents