Lymphoproliferative Disorders and De Novo Malignancies in Intestinal and Multivisceral Recipients: Improved Outcomes With New Outlooks

Abu‐Elmagd, Kareem; Mazariegos, George; Costa, Guilherme; Soltys, Kyle; Bond, Geoffrey; Sindhi, Rakesh; Green, Michael; Jaffe, Ronald; Wu, Tong; Koritsky, Darlene; Matarese, Laura E.; Schuster, Bonnie; Martin, L.; Dvorchik, Igor; Nalesnik, Michael A.

doi:10.1097/tp.0b013e3181b7509c

Cited by 96 publications

(64 citation statements)

References 40 publications

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“…Thus, while strategies aimed at altering therapeutic exposures (chemotherapy and radiation) will most likely result in a reduction in the risk of subsequent malignancies in some patients, it is unlikely that these exposures are the only factors that convey risk. In fact, it has been very well documented that recipients of solid organ allografts who subsequently require lifelong immunosuppression, also have a higher risk of developing malignancies presumably secondary to altered immune surveillance (89)(90)(91). In HCT recipients, the risk of SMNs is associated with duration of immunosuppression and also to cGVHD (likely from ongoing immunosuppression as opposed to an impact of GVHD itself) thus delayed immune recovery or persistent immunodeficiency may contribute to the risk of subsequent malignancy after HCT as well (2,21).…”

Section: Risk-reduction Strategiesmentioning

confidence: 99%

Subsequent Malignant Neoplasms After Hematopoietic Cell Transplantation

and

Bhatia

2015

Thomas’ Hematopoietic Cell Transplantation

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Section: Risk-reduction Strategiesmentioning

confidence: 99%

Subsequent Malignant Neoplasms After Hematopoietic Cell Transplantation

and

Bhatia

2015

Thomas’ Hematopoietic Cell Transplantation

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“…[59][60][61][62][63][64][65][66] Çocukluk çağı PTLH insidansı böbrek transplant alıcılarında %2,2, akciğer transplant alıcılarında %15, karaciğer ve kalp transplant alıcılarında %5 olarak bildirilirken, çoklu organ transplantlarının PTLH gelişimi açısından daha yüksek risk taşıdığı bildirilmektedir.…”

Section: Ri̇sk Faktörleri̇unclassified

Posttransplant Lymphoproliferative Diseases During Childhood: Review

Ince¹,

Demirağ²,

Vergin³

et al. 2015

Turkiye Klinikleri J Pediatr

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Ö ÖZ ZE ET T Posttransplant lenfoproliferatif hastalıklar (PTLH), solid organ transplantasyonu veya allojeneik hematopoietik kök hücre transplantasyonu (HKHT) sonrası immünsupresyona ikincil gelişen, benign poliklonal lenfoid proliferasyon ile malign monoklonal lenfoid proliferasyon arası spektruma sahip bir hastalık grubudur. Klinik tabloda belirgin morbidite ve mortalite riski mevcuttur, insidansı %1-30 arasında bildirilmektedir. Hastanın transplantasyon yaşı ve transplantasyon öncesinde Epstein-Barr virus (EBV) ile enfekte olma durumu, transplante edilen organın tipi, kullanılan immünsupresif rejim PTLH gelişmesini etkilemektedir. Dünya Sağ-lık Örgütü, PTLH için dört farklı morfolojik lezyon tanımlamıştır: Erken PTLH, polimorfik PTLH, monomorfik PTLH ve klasik Hodgkin lenfoma benzeri lezyonlar. Hasta değerlendirilirken alıcı ve vericinin EBV/sitomegalovirüs serolojisi; allogreftin tipi; transplantasyon sonrası ne kadar zaman geçtiği; alıcının transplantta yaşı dikkate alınmalıdır. PTLH immünolojik ve onkolojik bir hastalıktır. Günümüzde çocukluk çağı PTLH tedavisinde preemptif yaklaşımda uygulanan immünsupresyonun azaltılması, antiviral ajanların (± immünglobulin) yanı sıra standart tedavi yaklaşımı antrasiklin içermeyen, siklofosfamid, prednizolon ve rituksimab içeren azaltılmış doz kemoterapi uygulanmasıdır. Hedefe yönelik immün temele dayalı kombine tedavilerin kullanımı, rituksimab ve üçüncü parti EBV spesifik T-lenfositlerin kullanılmasıyla PTLH tedavisi güncel araştırma konularıdır. Günümüzde Türkiye'de giderek artan sayıda pediatrik solid organ transplantasyonu ve hematopoietik kök hücre transplantasyonu yapılmakta ve beraberinde giderek artan sayıda PTLH gelişen çocuk olgular bildirilmektedir. Ülkemizde çocuk hastalara özel bir transplantasyon kayıt sisteminin ve transplantasyon yapılan çocuk hasta grubunun gerek PTLH gelişme riski gerekse diğer onkolojik hastalıkların gelişme riski açısından standart bir izlem politikasının geliştirilmesine ihtiyaç bulunmaktadır. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Lenfoproliferatif bozukluklar; kemik iliği transplantasyonu; organ transplantasyonu; rituksimab; antineoplastik birleşik kemoterapi protokolleri A AB BS S T TR RA AC CT T Posttransplant lymphoproliferative diseases (PTLDs) which develop after solid organ transplantation and hematopoietic stem cell transplantation due to immune supression have a spectrum ranging from benign polyclonal lymphoid proliferation to malign monoclonal lymphoid proliferation. Its mortality and morbidity risks are significant with a reported incidence rate between 1-30%. The patient's age at transplantation, pretransplant Epstein-Barr virus (EBV) infection, the type of organ transplant, and used immunosuppressive regime have effects on PTLD development. The World Health Organization defines four different morphologic lesions for PTLD: Early PTLD, polymorphic PTLD, monomorphic PTLD, and classic Hodgkin lymphoma-like PTLD. While evaluating a patient, donor and recipient EBV/cytomegalovirus serologies; allograft ty...

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“…Seventy-one percent of PTLD episodes occur in the first year and 95% are related to Epstein-Barr virus infection, which is especially common in children. Nonlymphoid malignancies have also been reported in 3.2% of recipients and primarily in adults (54).…”

Section: De Novo Malignancymentioning

confidence: 99%

“…The most common malignancy to occur after intestine transplantation has been PTLD, occurring in 13% of recipients (53,54). Seventy-one percent of PTLD episodes occur in the first year and 95% are related to Epstein-Barr virus infection, which is especially common in children.…”

Section: De Novo Malignancymentioning

confidence: 99%

The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

Sudan

2014

American Journal of Transplantation

111

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Intestine transplantation is the least common form of organ transplantation in the United States and often deemed one of the most difficult. Patient and graft survival have historically trailed well behind other organ transplants. Over the past 5-10 years registry reports and single center series have demonstrated improvements to patient survival after intestinal transplantation that now match patient survival for those without life-threatening complications on parenteral nutrition. For various reasons including improvements in medical care of patients with intestinal failure and difficulty accessing transplant care, the actual number of intestine transplants has declined by 25% over the past 6 years. In light of the small numbers of intestine transplants, many physicians and the lay public are often unaware that this is a therapeutic option. The aim of this review is to describe the current indications, outcomes and advances in the field of intestine transplantation and to explore concerns over future access to this important and life-saving therapy.

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Lymphoproliferative Disorders and De Novo Malignancies in Intestinal and Multivisceral Recipients: Improved Outcomes With New Outlooks

Cited by 96 publications

References 40 publications

Subsequent Malignant Neoplasms After Hematopoietic Cell Transplantation

Subsequent Malignant Neoplasms After Hematopoietic Cell Transplantation

Posttransplant Lymphoproliferative Diseases During Childhood: Review

The Current State of Intestine Transplantation: Indications, Techniques, Outcomes and Challenges

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