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Lückemeier P, Radujkovic A, Holtick U, Kurch L, Monecke A, Platzbecker U, Herling M, Kayser S. Characterization and outcome of post-transplant lymphoproliferative disorders within a collaborative study. Front Oncol 2023; 13:1208028. [PMID: 37427100 PMCID: PMC10326719 DOI: 10.3389/fonc.2023.1208028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Post-transplant lymphoproliferative disorders (PTLD) are heterogeneous lymphoid disorders ranging from indolent polyclonal proliferations to aggressive lymphomas that can arise after solid organ transplantation (SOT) and allogeneic hematopoietic transplantation (allo-HSCT). Methods In this multi-center retrospective study, we compare patient characteristics, therapies, and outcomes of PTLD after allo-HSCT and SOT. Twenty-five patients (15 after allo-HSCT and 10 after SOT) were identified who developed PTLD between 2008 and 2022. Results Median age (57 years; range, 29-74 years) and baseline characteristics were comparable between the two groups (allo-HSCT vs SOT), but median onset of PTLD was markedly shorter after allo-HSCT (2 months vs. 99 months, P<0.001). Treatment regimens were heterogeneous, with reduction of immunosuppression in combination with rituximab being the most common first-line treatment strategy in both cohorts (allo-HSCT: 66%; SOT: 80%). The overall response rate was lower in the allo-HSCT (67%) as compared to the SOT group (100%). Consequently, the overall survival (OS) trended towards a worse outcome for the allo-HSCT group (1-year OS: 54% vs. 78%; P=0.58). We identified PTLD onset ≤150 days in the allo-HSCT (P=0.046) and ECOG >2 in the SOT group (P=0.03) as prognostic factors for lower OS. Conclusion PTLD cases present heterogeneously and pose unique challenges after both types of allogeneic transplantation.
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Affiliation(s)
- Philipp Lückemeier
- Department of Hematology, Cellular Therapy, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | | | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Astrid Monecke
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Marco Herling
- Department of Hematology, Cellular Therapy, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Sabine Kayser
- Department of Hematology, Cellular Therapy, and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Germany
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2
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Balaguer-Rosello A, Piñana JL, Bataller L, Montoro J, Romero S, Navarro I, Lorenzo I, Andreu R, Guerreiro M, Aguilar C, Gorriz D, Dominguez L, de la Puerta R, Gómez I, Solves P, Jarque I, Sanz MÁ, Sanz G, Sanz J. Central Nervous System Involvement in Epstein-Barr Virus-Related Post-Transplant Lymphoproliferative Disorders after Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2020; 27:261.e1-261.e7. [PMID: 33781531 DOI: 10.1016/j.jtct.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 11/12/2022]
Abstract
Central nervous system (CNS) involvement in Epstein-Barr virus-related post-transplant lymphoproliferative disorders (EBV-PTLDs) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is poorly defined. We analyzed the incidence, clinical and pathological characteristics, and impact on outcomes of EBV-PTLDs with CNS involvement (CNS-PTLDs) in 1009 consecutive adult patients undergoing allo-HSCT at a single-center institution. Four hundred eighty-two patients received matched sibling donor (MSD) transplants, 388 umbilical cord blood transplants (UCBTs), 56 matched unrelated donor (MUD) transplants, and 83 haploidentical transplants. We detected 25 cases of biopsy-proven EBV-PTLDs. Of these, nine patients (36%) had CNS-PTLDs: six after UCBT (67%), one after MSD transplantation (11%), one after MUD transplantation (11%), and one after haploidentical transplantation (11%). The 5-year cumulative incidence risk of CNS-PTLDs was 0.9%. Median time from transplant to CNS-PTLDs was 187 days, and all patients had neurological symptoms at diagnosis. Six out of the nine cases (67%) occurred with systemic involvement, and three cases (33%) had isolated CNS involvement. The most frequent histological subtype was monomorphic EBV-PTLD, and laboratory characteristics were similar to EBV-PTLDs without CNS involvement. We observed statistical differences in the rate of positive EBV DNA detection in plasma between isolated CNS-PTLDs (detection in one out of three, 33%) and the rest of the EBV-PTLDs (100%) (P = .01). Treatment strategies included chemotherapy, radiotherapy, and T cell therapy. However, seven out of nine patients died due to progression of the CNS-PTLDs at a median time of 17 days (range, 8 to 163) from diagnosis. The 5-years overall survival in patients who developed CNS-PTLDs was 22% (95% confidence interval [CI], 7% to 75%) and 5-year treatment-related mortality was 78% (95% CI, 51% to 100%), with no statistically significant differences between CNS-PTLDs and the rest of the EBV-PTLDs. In conclusion, despite advances in EBV monitoring and treatment strategies, CNS-PTLDs remain an uncommon but serious complication after allo-HSCT, with very poor prognosis.
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Affiliation(s)
- Aitana Balaguer-Rosello
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Luis Bataller
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Samuel Romero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Irene Navarro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rafael Andreu
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Cristobal Aguilar
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - David Gorriz
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lara Dominguez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalia de la Puerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Inés Gómez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
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3
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De-novo malignancies after kidney transplantation: A long-term observational study. PLoS One 2020; 15:e0242805. [PMID: 33253202 PMCID: PMC7703884 DOI: 10.1371/journal.pone.0242805] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. Methods This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies. Results 1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation. Conclusion De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.
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Gwon JG, Kim YH, Han DJ. Different causes of early and late-onset post transplant lymphoproliferative disorder in kidney transplantation patients after 2000. Asian J Surg 2018; 42:551-556. [PMID: 30327178 DOI: 10.1016/j.asjsur.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/17/2018] [Accepted: 09/03/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the link between PTLD incidence and its occurrence time in patients at a single center in comparable medical environments after 2000. METHODS Retrospectively, total 3305 kidney transplantation patients medical data were analyzed. Patients were divided into two groups based on the period from the day of kidney transplantation to the day of PTLD diagnosis. Early-onset was defined as PTLD development within two years after transplantation, whereas all other cases were categorized as late-onset PTLD. RESULTS In the early-onset group, young age (0-19 years) was confirmed as a risk factor for PTLD incidence (HR 1.49, p = 0.038). In the late-onset group, history of anti-rejection therapy was confirmed as a risk factor (HR 1.32, p = 0.031). Overall survival rates were not significantly different between the two groups (p = 0.556). Graft survival rates were also not different between the two groups (p = 0.549). CONCLUSION When patients with PTLD were classified into early-onset group and late-onset group at two years, overall survival and graft survival were comparable. And patients with early-onset PTLD are more likely to be associated with EBV, the late-onset patients are more likely to be immunosuppressed.
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Affiliation(s)
- Jun Gyo Gwon
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Young Hoon Kim
- Department of Kidney and Pancreas Transplantation Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Duck Jong Han
- Department of Kidney and Pancreas Transplantation Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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Romero S, Montoro J, Guinot M, Almenar L, Andreu R, Balaguer A, Beneyto I, Espí J, Gómez-Codina J, Iacoboni G, Jarque I, López-Andújar R, Mayordomo-Aranda E, Montalar J, Pastor A, Pastor M, Piñana JL, Rojas-Ferrer N, Sánchez-Lázaro I, Sandoval J, Sanz G, Sanz MÁ, Solé A, Sanz J. Post-transplant lymphoproliferative disorders after solid organ and hematopoietic stem cell transplantation. Leuk Lymphoma 2018; 60:142-150. [PMID: 29966464 DOI: 10.1080/10428194.2018.1474462] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Post-transplant lymphoproliferative disorders (PTLD) are a rare complication after both solid organ (SOT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this single center retrospective study, we compared clinical, biological, and histological features, and outcomes of PTLD after both types of transplant. We identified 82 PTLD (61 after SOT and 21 after allo-HSCT). The presence of B symptoms, Waldeyer ring, spleen, central nervous system, and liver involvement, and advanced Ann-Arbor stage were more frequent in allo-HSCT recipients. PTLD had an earlier onset in allo-HSCT than in SOT cohort (4 vs. 64 months, p < .0001). PTLD was EBV-positive in 100% of allo-HSCT, in contrast to 47% of SOT (p = .0002). Four years after PTLD diagnosis, median overall survival was 32% (95% CI, 22-48) and 10% (95% CI, 2-49) in SOT and allo-HSCT recipients, respectively (p = .002). In conclusion, the clinical presentation and the outcome of PTLD varies greatly depending on the type of transplant.
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Affiliation(s)
- Samuel Romero
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Juan Montoro
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Marta Guinot
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Luis Almenar
- c Cardiology Department , Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Rafael Andreu
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Aitana Balaguer
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Isabel Beneyto
- d Kidney Transplant Unit Hospital, Universitario y Politécnico La Fe , Valencia , Spain
| | - Jordi Espí
- d Kidney Transplant Unit Hospital, Universitario y Politécnico La Fe , Valencia , Spain
| | - José Gómez-Codina
- e Medical Oncology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Gloria Iacoboni
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Isidro Jarque
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Rafael López-Andújar
- f Hepatobiliopancreatic Surgery and Liver Transplant Unit Hospital, Universitario y Politécnico La Fe , Valencia , Spain
| | | | - Joaquín Montalar
- e Medical Oncology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Amparo Pastor
- h Lung Transplant Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Miguel Pastor
- e Medical Oncology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - José L Piñana
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
| | - Nohelia Rojas-Ferrer
- g Pathology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Ignacio Sánchez-Lázaro
- c Cardiology Department , Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Jesús Sandoval
- i Transplant Unit, Hospital de Especialidades del Centro Médico Nacional de Occidente , Guadalajara , Mexico
| | - Guillermo Sanz
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain.,j Department of Medicine , Universidad de Valencia , Valencia , Spain
| | - Miguel Á Sanz
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain.,j Department of Medicine , Universidad de Valencia , Valencia , Spain
| | - Amparo Solé
- h Lung Transplant Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Jaime Sanz
- a Hematology Department , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b CIBERONC (Centro de Investigación Biomédica en Red de Cáncer), Instituto Carlos III , Madrid , Spain
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Infusions of Epstein–Barr virus-specific cytotoxic T lymphocytes as post-remission therapy in high-risk post-transplant lymphoproliferative disorder patients: report of two cases. Int J Hematol 2017; 107:596-603. [DOI: 10.1007/s12185-017-2381-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/17/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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Koyawala N, Silber JH, Rosenbaum PR, Wang W, Hill AS, Reiter JG, Niknam BA, Even-Shoshan O, Bloom RD, Sawinski D, Nazarian S, Trofe-Clark J, Lim MA, Schold JD, Reese PP. Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation. J Am Soc Nephrol 2017; 28:2188-2200. [PMID: 28320767 DOI: 10.1681/asn.2016070768] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/24/2017] [Indexed: 12/24/2022] Open
Abstract
Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26; P<0.01) and death or allograft failure (HR, 1.18; 95% CI, 1.09 to 1.28; P<0.001). Results for death as well as death or allograft failure were generally consistent among elderly and nonelderly subgroups and among pairs receiving oral prednisone. Compared with rATG recipients, basiliximab recipients had higher risk of death (HR, 1.08; 95% CI, 1.01 to 1.16; P=0.03) and death or lymphoma (HR, 1.12; 95% CI, 1.01 to 1.23; P=0.03), although these differences were not confirmed in subgroup analyses. One-year resource utilization was slightly lower among alemtuzumab recipients than among rATG recipients, but did not differ between basiliximab and rATG recipients. This observational evidence indicates that, compared with alemtuzumab and basiliximab, rATG associates with lower risk of adverse outcomes, including mortality.
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Affiliation(s)
| | - Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics
| | - Paul R Rosenbaum
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Wang
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander S Hill
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph G Reiter
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bijan A Niknam
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Orit Even-Shoshan
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Roy D Bloom
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | - Deirdre Sawinski
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | | | - Jennifer Trofe-Clark
- Renal Electrolyte and Hypertension Division, Department of Medicine, and.,Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Mary Ann Lim
- Renal Electrolyte and Hypertension Division, Department of Medicine, and
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Peter P Reese
- Renal Electrolyte and Hypertension Division, Department of Medicine, and .,Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A. Post-transplant lymphoproliferative disorders: from epidemiology to pathogenesis-driven treatment. Cancer Lett 2015; 369:37-44. [PMID: 26279520 DOI: 10.1016/j.canlet.2015.08.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 02/07/2023]
Abstract
Post-transplant lymphoproliferative disorders (PTLDs) represent the most severe complication of both solid organ and hematopoietic stem cell transplantation. The Epstein-Barr Virus (EBV) is the main driver of PTLD, particularly those occurring early after transplantation. EBV-driven malignancies are associated with selective expression of latent viral proteins, but uncontrolled lytic replication may favor early phases of cell transformation. Besides immunodepression, persistent immune activation and chronic inflammation play an important role in both virus reactivation and expansion of EBV-infected B cells. EBV-induced immortalization requires the expression of telomerase. TERT, the rate-limiting component of the telomerase complex, is central in the switch from the lytic to the latent viral program, and TERT inhibition induces the EBV lytic cycle and cell death. Immunotherapy and combination of EBV lytic cycle inducers with antiviral drugs are promising strategies to improve the treatment of PTLD patients. This review is aimed at providing an update on the intriguing association between EBV and PTLD, mainly focusing on cases arising after kidney and liver transplantation, which account for the vast majority of transplants.
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Affiliation(s)
- Maria Raffaella Petrara
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy; Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Silvia Giunco
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Diego Serraino
- Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy
| | - Riccardo Dolcetti
- Cancer Bio-Immunotherapy Unit, Centro di Riferimento Oncologico (CRO)-IRCCS, National Cancer Institute, Aviano (PN), Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy; Viral Oncology Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy.
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