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移植后淋巴增殖性疾病的筛查与管理

Screening and Management of PTLD.

作者信息

Zaffiri Lorenzo, Chambers Eileen T

机构信息

Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

Department of Pediatrics, Duke University, Durham, NC.

出版信息

Transplantation. 2023 Nov 1;107(11):2316-2328. doi: 10.1097/TP.0000000000004577. Epub 2023 Oct 21.

Abstract

Posttransplant lymphoproliferative disorder (PTLD) represents a heterogeneous group of lymphoproliferative diseases occurring in the setting of immunosuppression following hematopoietic stem cells transplant and solid organ transplantation. Despite its overall low incidence, PTLD is a serious complication following transplantation, with a mortality rate as high as 50% in transplant recipients. Therefore, it is important to establish for each transplant recipient a personalized risk evaluation for the development of PTLD based on the determination of Epstein-Barr virus serostatus and viral load following the initiation of immunosuppression. Due to the dynamic progression of PTLD, reflected in the diverse pathological features, different therapeutic approaches have been used to treat this disorder. Moreover, new therapeutic strategies based on the administration of virus-specific cytotoxic T cells have been developed. In this review, we summarize the available data on screening and treatment to suggest a strategy to identify transplant recipients at a higher risk for PTLD development and to review the current therapeutic options for PTLD.

摘要

移植后淋巴细胞增殖性疾病(PTLD)是一组异质性的淋巴细胞增殖性疾病,发生于造血干细胞移植和实体器官移植后的免疫抑制环境中。尽管其总体发病率较低,但PTLD是移植后的一种严重并发症,移植受者的死亡率高达50%。因此,在免疫抑制开始后,根据爱泼斯坦-巴尔病毒血清状态和病毒载量的测定,为每个移植受者建立个性化的PTLD发生风险评估非常重要。由于PTLD的动态进展,体现在多样的病理特征上,已采用不同的治疗方法来治疗这种疾病。此外,基于病毒特异性细胞毒性T细胞给药的新治疗策略也已开发出来。在本综述中,我们总结了关于筛查和治疗的现有数据,以提出一种策略来识别发生PTLD风险较高的移植受者,并回顾PTLD目前的治疗选择。

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