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Management of PTLD After Hematopoietic Stem Cell Transplantation: Immunological Perspectives

Management of PTLD After Hematopoietic Stem Cell Transplantation: Immunological Perspectives

Authors :
Francesca Compagno
Sabrina Basso
Arianna Panigari
Jessica Bagnarino
Luca Stoppini
Alessandra Maiello
Tommaso Mina
Paola Zelini
Cesare Perotti
Fausto Baldanti
Marco Zecca
Patrizia Comoli
Source :
Frontiers in Immunology, Vol 11 (2020)
Publication Year :
2020
Publisher :
Frontiers Media S.A., 2020.

Abstract

Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening complications of iatrogenic immune impairment after allogeneic hematopoietic stem cell transplantation (HSCT). In the pediatric setting, the majority of PTLDs are related to the Epstein–Barr virus (EBV) infection, and present as B-cell lymphoproliferations. Although considered rare events, PTLDs have been increasingly observed with the widening application of HSCT from alternative sources, including cord blood and HLA-haploidentical stem cell grafts, and the use of novel agents for the prevention and treatment of rejection and graft-vs.-host disease. The higher frequency initially paralleled a poor outcome, due to limited therapeutic options, and scarcity of controlled trials in a rare disease context. In the last 2 decades, insight into the relationship between EBV and the immune system, and advances in early diagnosis, monitoring and treatment have changed the approach to the management of PTLDs after HSCT, and significantly ameliorated the prognosis. In this review, we summarize literature on the impact of combined viro-immunologic assessment on PTLD management, describe the various strategies for PTLD prevention and preemptive/curative treatment, and discuss the potential of novel immune-based therapies in the containment of this malignant complication.

Details

Language :
English
ISSN :
16643224
Volume :
11
Database :
Directory of Open Access Journals
Journal :
Frontiers in Immunology
Publication Type :
Academic Journal
Accession number :
edsdoj.be6f159cef40c9b6111c33bcb16ce3
Document Type :
article
Full Text :
https://doi.org/10.3389/fimmu.2020.567020