Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.
Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.
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DOI：
10.1097/qco.0000000000000787
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发表时间：
2021-12-01
影响因子：
3.9
通讯作者：
Slavin MA
中科院分区：
文献类型：
--
作者：
Lindsay J;Othman J;Heldman MR;Slavin MA
Epstein-Barr病毒移植后淋巴组织增生性疾病（EBV PTLD）的管理是复杂的，涉及风险分层，预防和/或先发制人的措施，包括监测EBV DNA血症和平衡治疗选择，使用减少免疫抑制，抗B细胞治疗和细胞毒性T淋巴细胞（CTL）的组合。造血细胞移植（HCT）中发生EBV PTLD的最高风险因素仍然是T细胞耗竭，在预处理中越来越多地使用抗胸腺细胞球蛋白（ATG）或Alemtuzumab。在实体器官移植（SOT）中，PTLD的发病率在EBV血清阴性受者中最高，这些受者在移植后的前12个月内有原发性EBV感染的风险。预防是EBV PTLD管理的关键组成部分。虽然预防性治疗仍然是标准的护理，仍然存在异质性和争论的最佳选择的EBV DNA定量和阈值使用。新的治疗方法，如供体来源的多病原体和EBV特异性CTL用于预防和第三方CTL用于治疗EBV-PTLD是有希望的，证据迅速扩大，包括目前正在进行的大规模III期试验。随着HCT和SOT中发生EBV PTLD的风险组数量的增加，使用预防或先发制人治疗的管理策略仍然是护理标准，然而，使用预防性或先发制人的EBV特异性或多病原体CTL显示出有希望的结果和安全性特征。
Management of Epstein-Barr virus post-transplant lymphoproliferative disorder (EBV PTLD) is complex, involving risk stratification, prevention and/or pre-emptive measures involving monitoring EBV DNAemia and balancing treatment options, using a combination of reduction of immune suppression, anti-B cell therapy, and cytotoxic T lymphocytes (CTLs). The highest risk factor for the development of EBV PTLD in hematopoietic cell transplant (HCT) remains T cell depletion, with increasing use of anti-thymocyte globulin (ATG) or alemtuzumab in conditioning. In solid organ transplantation (SOT), the incidence of PTLD is highest among EBV seronegative recipients who are at risk for primary EBV infection following transplant in the first 12 months. Prevention is a critical component of the management of EBV PTLD. Although pre-emptive therapy remains standard of care, there continues to be heterogenicity and debate over the optimal choice of EBV DNA quantification and the threshold to use. Novel therapies such as donor-derived multi-pathogen and EBV specific CTLs for the prevention and third party CTLs for the treatment of EBV-PTLD are promising, with rapidly expanding evidence, including large scale Phase III trials currently underway. With an increasing number of risk groups for developing EBV PTLD in HCT and SOT, management strategies using prophylaxis or pre-emptive therapy remain standard of care, however the use of prophylactic or pre-emptive EBV specific or multi-pathogen CTLs show promising results and safety profiles.