Department of Hematology, Yale Cancer Center, Smilow Cancer Hospital, New Haven, USA.
Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Departments of Pediatrics and Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Mailman School of Public Health, 722 West 168th street, Room 730, New York, NY, 10032, USA.
Curr Hematol Malig Rep. 2021 Feb;16(1):52-60. doi: 10.1007/s11899-021-00606-8. Epub 2021 Feb 5.
Post-transplant lymphoproliferative disorders are a rare and heterogeneous group of diseases, where large prospective studies have been difficult to perform and treatment paradigms are often based on retrospective studies. Here, we critically analyze and present the clinical algorithms commonly used for this disease, with a special focus on the challenges and differences of the approaches in the adult and pediatric populations.
Clinical trials exploring combinations of immunochemotherapies with a sequential and risk-stratified strategy have demonstrated exciting results, but are hampered from specialty and age-determined silos. Approaches introducing novel-targeted therapies and cellular therapies are currently being explored with a goal of joining efforts across the pediatric and adult age spectra. We propose that future therapeutic approaches would benefit from combining pediatric and adult PTLD efforts, gaining from the experience garnered from the age- and subtype-specific tailored strategies, with the aim of limiting treatment-related toxicities while maximizing the efficacy. Joining of efforts holds enormous potential for accelerating access to novel therapeutic strategies for PTLD in the near future.
移植后淋巴组织增生性疾病是一组罕见且异质性的疾病,很难进行大型前瞻性研究,治疗方案通常基于回顾性研究。在这里,我们批判性地分析和介绍了常用于该疾病的临床算法,特别关注成人和儿科人群中方法的挑战和差异。
探索免疫化疗联合序贯和风险分层策略的临床试验取得了令人兴奋的结果,但受到专业和年龄决定的孤立的阻碍。目前正在探索引入新型靶向治疗和细胞治疗的方法,目的是跨越儿科和成人年龄范围共同努力。我们提出,未来的治疗方法将受益于结合儿科和成人 PTLD 的努力,从针对年龄和亚型的量身定制策略中获得经验,旨在限制治疗相关毒性,同时最大限度地提高疗效。共同努力在不久的将来为加速获得新型治疗 PTLD 的策略提供了巨大的潜力。