Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies.
Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies.
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DOI：
10.1007/s11899-013-0162-5
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发表时间：
2013-09
影响因子：
2.9
通讯作者：
Evens AM
中科院分区：
文献类型：
--
作者：
Al-Mansour Z;Nelson BP;Evens AM
移植后淋巴组织增生性疾病（PTLD）是异质性淋巴系统疾病，从惰性多克隆增殖到侵袭性淋巴瘤，使实体器官或造血移植复杂化。风险因素已经确定，包括病毒感染，免疫抑制程度，受体年龄和种族，同种异体移植类型和宿主遗传变异。临床上，结外疾病很常见，10- 15%表现为中枢神经系统（CNS）疾病。大多数PTLD病例是B细胞（5- 10% T/NK细胞或霍奇金淋巴瘤），而大约三分之一是EBV阴性。世界卫生组织（WHO）的诊断类别是：早期病变，多态性和单态性PTLD;尽管在实践中，并不总是可能明确区分。在治疗上，减少免疫抑制仍然是一个主流，最近的数据已经证明了利妥昔单抗+/−联合化疗的重要性。原发性CNS PTLD的治疗应根据免疫活性CNS范例进行管理。最后，PTLD的新治疗策略已经出现，包括过继免疫治疗和合理的靶向治疗（例如，靶向病毒编码的潜伏膜蛋白-2A的下游信号传导途径）。
Post-transplant lymphoproliferative diseases (PTLD) are heterogeneous lymphoid disorders ranging from indolent polyclonal proliferations to aggressive lymphomas that complicate solid organ or hematopoietic transplantation. Risk factors have been identified, including viral infections, degree of immunosuppression, recipient age and race, allograft type, and host genetic variations. Clinically, extra-nodal disease is common, with 10–15 % presenting with central nervous system (CNS) disease. Most PTLD cases are B cell (5–10 % T/NK cell or Hodgkin lymphoma), while approximately one-third are EBV-negative. World Health Organization (WHO) diagnostic categories are: early lesions, polymorphic, and monomorphic PTLD; although in practice, a clear separation is not always possible. Therapeutically, reduction in immunosuppression remains a mainstay, and recent data has documented the importance of rituximab +/− combination chemotherapy. Therapy for primary CNS PTLD should be managed according to immunocompetent CNS paradigms. Finally, novel treatment strategies for PTLD have emerged, including adoptive immunotherapy and rational targeted therapeutics (e.g., targeting downstream signaling pathways of virus-encoded latent membrane protein-2A).