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- Title
Front‐line management of post‐transplantation lymphoproliferative disorder in adult solid organ recipient patients — A British Society for Haematology Guideline.
- Authors
Shah, Nimish; Eyre, Toby A.; Tucker, David; Kassam, Shireen; Parmar, Jasvir; Featherstone, Carrie; Andrews, Peter; Asgari, Elham; Chaganti, Sridhar; Menne, Tobias F.; Fox, Christopher P.; Pettit, Stephen; Suddle, Abid; Bowles, Kristian M.
- Abstract
This is not an unreasonable approach to adopt in selected patients and furthermore, González-Barca I et al i . demonstrated good responses in a prospective phase II trial where 83-3% of patients that achieved PR after rituximab monotherapy progressed to CR with extended treatment with rituximab only.45 Not all patients will be fit for combination chemotherapy as described above. Keywords: lymphomas; transplantation; lymphoproliferative disease; Epstein-Barr virus; immunodeficiency EN lymphomas transplantation lymphoproliferative disease Epstein-Barr virus immunodeficiency 727 740 14 05/17/21 20210515 NES 210515 This document is an updated guideline and details the recommendations for the front-line management of adult patients with an established diagnosis of post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation (SOT). EBV-specific CTLs utilise either the recipient's own cells to generate autologous EBV-directed CTLs or a bank of partially HLA-matched EBV-specific CTLs to generate a T-cell immune-mediated response to these abnormal B cells.84-88 If available, autologous or allogeneic EBV-directed CTLs should be considered in patients with R/R EBV-positive PTLD. However, in several recent case series, ORR appears higher than expected (55-75%) regardless of treatment modality, with a median OS in the range of 33-47 months.107,110 The optimal therapy for CNS-PTLD has not been established and comorbidity may limit treatment options in many patients. Patients with R/R PTLD post R-CHOP have a poor long-term survival with OS < 20% as conventional salvage approaches with consolidation autologous stem cell transplantation (ASCT) are challenging to deliver in SOT patients.78,79 Extrapolating treatments from R/R DLBCL in immunocompetent patients is reasonable80-83 but this approach has little evidence in R/R PTLD.
- Subjects
MUCOSA-associated lymphoid tissue lymphoma; CASTLEMAN'S disease; LYMPHOPROLIFERATIVE disorders; ADULTS; DIFFUSE large B-cell lymphomas; HEMATOLOGY; MULTIPLE myeloma
- Publication
British Journal of Haematology, 2021, Vol 193, Issue 4, p727
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/bjh.17421