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Post-transplant Lymphoproliferative Disorders

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Non-Hodgkin Lymphoma

Part of the book series: Cancer Treatment and Research ((CTAR,volume 165))

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are a serious complication after solid organ or allogeneic hematopoietic stem cell transplantation and include a range of diseases from benign proliferations to malignant lymphomas. Risk factors for developing PTLD include Epstein-Barr virus (EBV) infection, recipient age, transplanted organ, type of immunosuppression, and genetics. Uncontrolled proliferation of EBV-infected B cells is implicated in EBV-positive PTLD, whereas the pathogenesis of EBV-negative PTLD may be similar to non-Hodgkin’s lymphoma in the general population. The World Health Organization (WHO) classifies PTLD into four categories: early lesions, polymorphic PTLD, monomorphic PTLD, and classical Hodgkin’s lymphoma (cHL). Treatment is aimed at cure of PTLD, while maintaining transplanted organ function. However, there are no established guidelines for the treatment of PTLD. Immune suppression reduction (ISR) is the first line of treatment in most cases, with more recent data suggesting early use of rituximab. In more aggressive forms of PTLD, upfront chemotherapy may offer a better and more durable response. Sequential therapy using rituximab followed by chemotherapy has demonstrated promising results and may establish a standard of care. Novel therapies including anti-viral agents, adoptive immunotherapy, and monoclonal antibodies targeting cytokines require further study in the prevention and treatment of PTLD.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Arun K. Singavi

  2. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    Alexandra M. Harrington

  3. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Timothy S. Fenske

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  1. Arun K. Singavi
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  2. Alexandra M. Harrington
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  3. Timothy S. Fenske
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Correspondence to Timothy S. Fenske .

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  1. Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA

    Andrew M. Evens

  2. Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA

    Kristie A. Blum

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Singavi, A.K., Harrington, A.M., Fenske, T.S. (2015). Post-transplant Lymphoproliferative Disorders. In: Evens, A., Blum, K. (eds) Non-Hodgkin Lymphoma. Cancer Treatment and Research, vol 165. Springer, Cham. https://doi.org/10.1007/978-3-319-13150-4_13

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