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Clin Dev Immunol. 2013;2013:814973. doi: 10.1155/2013/814973. Epub 2013 Sep 24.

Posttransplant lymphoproliferative disease after pediatric solid organ transplantation.

Author information

1
Department of Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany ; Integrated Research and Treatment Center Transplantation, Hannover Medical School, 30625 Hannover, Germany.

Abstract

Patients after solid organ transplantation (SOT) carry a substantially increased risk to develop malignant lymphomas. This is in part due to the immunosuppression required to maintain the function of the organ graft. Depending on the transplanted organ, up to 15% of pediatric transplant recipients acquire posttransplant lymphoproliferative disease (PTLD), and eventually 20% of those succumb to the disease. Early diagnosis of PTLD is often hampered by the unspecific symptoms and the difficult differential diagnosis, which includes atypical infections as well as graft rejection. Treatment of PTLD is limited by the high vulnerability towards antineoplastic chemotherapy in transplanted children. However, new treatment strategies and especially the introduction of the monoclonal anti-CD20 antibody rituximab have dramatically improved outcomes of PTLD. This review discusses risk factors for the development of PTLD in children, summarizes current approaches to therapy, and gives an outlook on developing new treatment modalities like targeted therapy with virus-specific T cells. Finally, monitoring strategies are evaluated.

PMID:
24174972
PMCID:
PMC3794558
DOI:
10.1155/2013/814973
[Indexed for MEDLINE]
Free PMC Article

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