Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009 ...

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Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009 ...

Post-transplant lymphoproliferative disorder255Another potential therapeutic strategy could be totry to induce lytic EBV infection in the tumor cells. Thiscould be done by targeting genes that switch the EBVinfectedB cells from the latent to the lytic cycle 81 .CONCLUSIONSTransplantation and the accompanying drug-inducedimmunosuppression put patients at risk for potentiallyfatal infection and malignancy. As the number of transplantsincrease and the life expectancy of transplant recipientsimproves, increased rates of PTLD and othermalignancies are anticipated. Among those who are ina high risk of developing PTLD are EBV-seronegativepatients, nonrenal transplant recipients, patients withintense immunosuppression management, and children.To prevent PTLD, minimizing the immunosuppressionburden, regular PCR EBV screening and use of antiviralagents appear to be useful strategies. PTLD treatmentincludes lowering of immunosuppression, antiviral therapy,surgical support, chemotherapy, radiation and cellulartherapy. However, the optimal therapy strategy stillremains to be determined. There is still a great necessityfor prospective randomized clinical trials to test the effectivenessof current strategies. Productive areas of investigationinclude: identifying patients who will benefitfrom reduction of immunosuppression only; improvingmethods for predicting those at highest risk of PTLD;developing safe and effective pre-emptive therapies; anddeveloping more effective, less toxic therapies for resistantor aggressive disease.REFERENCES1. Swin nen LJ. Treatment of organ transplant–related lymphoma.Hematol Oncol Clin North Am 1997;11:963–973.2. Boubenider S, Hiesse C, Goupy C, Kriaa F, Marchand S, CharpentierB. Incidence and consequences of posttransplant lymphoproliferativedisorders. J Nephrol 1997;10:136–145.3. Nale snik MA. 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