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Post-transplant lymphoproliferation disease : treatment and prognosis Volume 4, issue 6, Novembre - Décembre 1998

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Post-transplant lymphoproliferative diseases (PTLDs) are a clinically and morphogically heterogeneous group of lymphoid proliferations. They represent a life-threatening complication of solid organ transplantation. Mechanisms of their pathogenesis have not been yet fully understood. A combination of impaired immune surveillance, oncogenic consequences of immunosuppressive therapy and EBV infection may play a role. The small absolute number of cases occurring at each single transplant center and the lack of reliable classification render studies about incidence, treatment and prognosis difficult. Overall mortality remains high even though 25 % of patients will require no other measure than immunosuppression reduction. Several treatments are currently used but a more adequate classification as well as multicentric studies are urgently needed because there are still many controversies with regard to the best therapeutic strategy. Late-onset monoclonal tumors may be treated by conventional chemotherapy, while EBV-positive PTLDs may benefit from other approaches such as immunologic modulation of the tumor functions.