Taylor Anna L, Marcus Robert, Bradley J Andrew
Department of Surgery, University of Cambridge Clinical School, Box 202, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
Crit Rev Oncol Hematol. 2005 Oct;56(1):155-67. doi: 10.1016/j.critrevonc.2005.03.015.
Post-transplant lymphoproliferative disorders (PTLD) are a well-recognised and potentially fatal complication after solid organ transplantation. They include a spectrum of disorders ranging from benign hyperplasia to invasive malignant lymphoma. The majority of cases are associated with Epstein Barr virus (EBV)-driven tumour formation in B cells and are a consequence of the detrimental effect of immunosuppressive agents on the immune-control of EBV. This review provides an update on the pathogenesis and clinical features of PTLD after solid organ transplantation and discusses recent progress in management. Reduction in immunosuppressive therapy remains a key component of therapy for EBV-positive PTLD and may lead to remission in early disease. Chemotherapy is used when reduced immunosuppression fails to control early disease and as initial therapy for many cases of late disease. Unfortunately, the mortality for PTLD that fails to respond to a reduction in immunosuppression remains high. Newer treatments include manipulation of the cytokine environment, B lymphocyte depleting antibodies and adoptive T cell immunotherapy using allogeneic or autologous EBV-specific cytotoxic T lymphocytes. Although early results appear promising, well-designed clinical trials are needed to assess the efficacy of these novel approaches. EBV vaccination may in the future prove an effective prophylaxis against EBV-driven PTLD but until then, avoiding excessive immunosuppressive therapy may help minimise the risk of PTLD.
移植后淋巴组织增生性疾病（PTLD）是实体器官移植后一种公认的、可能致命的并发症。它们包括一系列疾病，从良性增生到侵袭性恶性淋巴瘤。大多数病例与EB病毒（EBV）驱动的B细胞肿瘤形成有关，是免疫抑制剂对EBV免疫控制产生有害影响的结果。本综述提供了实体器官移植后PTLD发病机制和临床特征的最新信息，并讨论了治疗方面的最新进展。减少免疫抑制治疗仍然是EBV阳性PTLD治疗的关键组成部分，可能会使早期疾病缓解。当减少免疫抑制无法控制早期疾病时，化疗被用作许多晚期疾病的初始治疗。不幸的是，对免疫抑制减少无反应的PTLD死亡率仍然很高。新的治疗方法包括调节细胞因子环境、使用B淋巴细胞清除抗体以及使用同种异体或自体EBV特异性细胞毒性T淋巴细胞进行过继性T细胞免疫治疗。虽然早期结果看起来很有希望，但需要精心设计的临床试验来评估这些新方法的疗效。EBV疫苗接种未来可能被证明是预防EBV驱动的PTLD的有效措施，但在此之前，避免过度免疫抑制治疗可能有助于将PTLD的风险降至最低。
