Managing post-transplant lymphoproliferative disorders in solid-organ transplant recipients: A review of immunosuppressant regimens

Vidhya Murukesan, Sandeep Mukherjee

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of potentially life-threatening complications that occur after solid organ and bone marrow transplantation. Risk factors for acquiring PTLD are type of organ transplanted, age, intensity of immunosuppression, viral infections such as Epstein-Barr virus (EBV) and time after transplantation. Due to a dearth of well designed prospective trials, treatment for PTLD is often empirical, with reduction in immunosuppression accepted as the first step. Rituximab, a monoclonal antibody directed against the CD20 antigen of immature B cells, is often used as monotherapy after reduction in immunosuppression, although this is associated with a high risk of relapse if patients have at least one of the following risk factors: age greater than 60 years, elevated lactate dehydrogenase levels and Eastern Cooperative Oncology Group Score between 2 and 4. For such patients, rituximab should be considered in combination with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone), particularly if high-grade PTLD is present.Although widely prescribed, the use of ganciclovir for PTLD remains controversial as EBV-transformed cells lack the thymidine kinase necessary for ganciclovir activation. Newer antivirals that combine ganciclovir with activators of cellular thymidine kinase have shown promising results in preclinical studies. In the absence of controlled trials, surgery may be indicated for localized disease and radiotherapy for patients with impending spinal cord compression or disease localized to the central nervous system or orbit.Future interventions may include adoptive immunotherapy, intravenous immunoglobulin, mammalian target of rapamycin inhibitors, monoclonal antibodies to interleukin-6 and galectin-1, and even EBV vaccination. Although several trials are in progress, it is necessary to wait for the long-term outcome of these studies on risk of PTLD relapse.

Original languageEnglish
Pages (from-to)1631-1643
Number of pages13
JournalDrugs
Volume72
Issue number12
DOIs
StatePublished - 2012
Externally publishedYes

Fingerprint

Lymphoproliferative Disorders
Immunosuppressive Agents
Transplants
Ganciclovir
Human Herpesvirus 4
Immunosuppression
Thymidine Kinase
CD20 Antigens
Monoclonal Antibodies
Galectin 1
Adoptive Immunotherapy
Recurrence
Spinal Cord Compression
B-Lymphoid Precursor Cells
Spinal Cord Diseases
Intravenous Immunoglobulins
Vincristine
Orbit
Virus Diseases
Sirolimus

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Managing post-transplant lymphoproliferative disorders in solid-organ transplant recipients : A review of immunosuppressant regimens. / Murukesan, Vidhya; Mukherjee, Sandeep.

In: Drugs, Vol. 72, No. 12, 2012, p. 1631-1643.

Research output: Contribution to journalReview article

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