Post-Transplant Lymphoproliferative Disorders

3642016529
Post-Transplant Lymphoproliferative Disorders
Dedication
Foreword
Contents
Contributors
Chapter 1
	Introduction
		References
Chapter 2
	Historical Perspective on the Early Studies of Posttransplant Lymphoproliferative Disorders (PTLD)
		2.1 Malignancies in Immunocompromised Hosts
		2.2 The Epstein–Barr Virus
		2.3 The Serendipitous Intersection of Immunosuppression and EBV
		2.4 Initial Studies of “Posttransplant Lymphoma”
		2.5 Growing Experience with EBV and Posttransplant Lymphoproliferative Diseases
		2.6 Clinical Spectrum of Lymphoproliferative Disorders
		2.7 Morphology
		2.8 Clonality
		2.9 EBV
		2.10 Therapy
		2.11 Summary Classification of PTLD
		2.12 Pathogenesis
		2.13 Conclusions
		2.14 Take Home Pearls
		References
Chapter 3
	Epidemiology of PTLD
		3.1 Introduction
		3.2 Incidence of PTLD
		3.3 Time to PTLD
		3.4 Risk Factors for PTLD
			3.4.1 Infection Related Risk Factors
			3.4.2 Host-Related Risk Factors
			3.4.3 Primary Disease Related Factors
			3.4.4 Graft Organ Related Risk Factors
			3.4.5 Immunosuppression Related Risk Factors
		3.5 Mortality After PTLD
		3.6 Risk for Graft Loss After PTLD
		3.7 Re-Transplantation After PTLD in Prior Transplant
		3.8 Take Home Messages
		References
Chapter 4
	The Biology of Epstein–Barr Virus and Posttransplant Lymphoproliferative Disease
		4.1 Introduction
		4.2 Biology of EBV
			4.2.1 Infection
			4.2.2 The Viral Life Cycle
			4.2.3 Latent Cycle Genes of EBV
			4.2.4 Characteristics of the T Cell Response to EBV in Healthy Individuals
			4.2.5 Characteristics of the T Cell Response to EBV in Transplant Recipients
		4.3 PTLD
			4.3.1 Viral Determinants that Drive Growth and Survival of PTLD-Associated B Cell Lymphomas
			4.3.2 Viral Mechanisms of Immune Evasion or Subversion
			4.3.3 Direct Eff ects of Immunosuppression on Viral Infection and Tumor Cell Growth
		4.4 Conclusion
		4.5 Take Home Pearls
		References
Chapter 5
	Epstein–Barr Viral Load Testing: Role in the Prevention, Diagnosis and Management of Posttransplant Lymphoproliferative Disorders
		5.1 Introduction
		5.2 EBV VL Assessments-What Is Being Measured?
		5.3 Limitations and Unresolved Issues Related to EBV VL Assays
		5.4 Lack of Standardization and Cross-Referencing of Assays
		5.5 Specimen Type and Reporting Units
		5.6 The Use of EBV VL Assessments for Specifi c Clinical Purposes
			5.6.1 EBV VL Assessments for Preemptive Programs Targeting PTLD Prevention
			5.6.2 Laboratory Tests as Adjuncts to EBV VL Assessments
			5.6.3 Laboratory Monitoring Algorithms
			5.6.4 Defining Trigger Points for Preemptive Interventions
		5.7 EBV VL Assessment for PTLD Diagnosis
		5.8 EBV VL Assessments for Monitoring Response to PTLD Therapy and Predicting Relapse
		5.9 EBV VL Assessments for Determining the Impact of New Immunosuppressive Regimens and Tailoring Individual Immunosuppression
		5.10 Take Home Pearls
		References
Chapter 6
	Clinical Features and Diagnostic Evaluation of Posttransplant Lymphoproliferative Disorder
		6.1 Introduction
			6.1.1 Severe Infectious Mononucleosis, Clinical Categories, and Sites of PTLD
			6.1.2 Clinicopathologic Correlates
			6.1.3 Diagnostic Evaluation
				6.1.3.1 Background Information on Patients
				6.1.3.2 Initial Clinical Examination
				6.1.3.3 Diagnostic and Screening Tests
					General Tests and Non-EBV Specific Tests
					EBV Specific Tests
					Histopathology
			6.1.4 Clinical Staging of PTLD
			6.1.5 Differential Diagnoses
			6.1.6 Ten Take Home Pearls
			References
Chapter 7
	Pathology
		7.1 Introduction
			7.1.1 General Pathologic Features and Classification
			7.1.2 Differential Diagnosis
			7.1.3 Multiparameter Approach to the Diagnosis of PTLD
		7.2 Early Lesions
			7.2.1 Plasmacytic Hyperplasia (PCH)
				7.2.1.1 Histopathology
				7.2.1.2 Ancillary Studies
			7.2.2 Infectious Mononucleosis (IM)-Like PTLD
				7.2.2.1 Histopathology
				7.2.2.2 Ancillary Studies
			7.2.3 Florid Follicular Hyperplasia
			7.2.3.1 Histopathology
			7.2.3.2 Ancillary Studies
		7.3 Polymorphic PTLD
			7.3.1 Histopathology
			7.3.2 Ancillary Studies
		7.4 Monomorphic PTLD
			7.4.1 Monomorphic B-Cell PTLD
				7.4.1.1 Histopathology
				7.4.1.2 Ancillary Studies
			7.4.2 Monomorphic T-Cell PTLD
				7.4.2.1 Histopathology
				7.4.2.2 Ancillary Studies
		7.5 Classical Hodgkin Lymphoma Type PTLD
			7.5.1 Histopathology
			7.5.2 Ancillary Studies
		7.6 Take Home Pearls
		References
Chapter 9
	Treatment of PTLD
		9.1 Introduction
		9.2 Optimal Therapy for PTLD
		9.3 Reduction of Immune Suppression
		9.4 Surgery and Radiation Therapy
		9.5 Antiviral Therapy
		9.6 Interferon and Other Cytokines
		9.7 Intravenous Immune Globulin
		9.8 Anti-B Cell Antibodies
		9.9 Chemotherapy
		9.10 Cellular Immunotherapy
		9.11 Role of Combination Therapies
		9.12 Central Nervous System Disease
		9.13 Monitoring Patients During Therapy
			9.13.1 Conventional Monitoring of Graft and PTLD Status
			9.13.2 EBV Viral Load Monitoring
			9.13.3 Cellular Immune Responses
		9.14 Conclusions
		9.15 Take Home Pearls
		References
Chapter 10
	Prevention of Epstein–Barr Virus Infection and Posttransplant Lymphoproliferative Disease Following Transplantation
		10.1 Introduction
		10.2 Chemoprophylaxis Using Antiviral Therapy
			10.2.1 Mechanisms of Action of Acyclovir and Ganciclovir
			10.2.2 Animal Models of Chemoprophylaxis
			10.2.3 Clinical Studies of Chemoprophylaxis
		10.3 Immunoprophylaxis
			10.3.1 Cellular Therapy
			10.3.2 Passive Immunization
			10.3.3 Active Immunization
		10.4 Viral Load Monitoring and Preemptive Strategies of Prevention
		10.5 Take Home Pearls
		References
Chapter 11.a
	Organ Specific Issues of PTLD – Kidney
		11.a.1 Epidemiology
		11.a.2 Clinical Presentation
		11.a.3 Therapeutic Aspects
		11.a.4 Outcome and Prognostic Factors
		11.a.5 Take Home Pearls
		References
Chapter 11.b
	Posttransplantation Lymphoproliferative Disorder (PTLD) in Liver and Small Bowel Transplant Recipients
		11.b.1 Introduction
		11.b.2 PTLD Following Liver Transplantation
			11.b.2.1 Incidence
			11.b.2.2 Risk Factors
			11.b.2.3 Presentation
			11.b.2.4 Treatment
				11b.2.4.1 Reduction or Discontinuation of Immunosuppression and Antiviral Therapies
				11.b.2.4.2 Surgery and Radiotherapy
				11.b.2.4.3 Monoclonal Antibodies
				11.b.2.4.5 Conventional Chemotherapy
			11.b.2.5 Prognosis
		11.b.3 PTLD Following Small Bowel Transplantation
			11.b.3.1 Incidence
			11.b.3.2 Risk Factors
			11.b.3.3 Presentation
			11.b.3.4 Treatment
		11.b.4 Take Home Pearls
		References
Chapter 11.c
	Heart and Lung Transplantation
		11.c.1 Introduction
		11.c.2 PTLD After Heart Transplantation
			11.c.2.1 Epidemiology
			11.c.2.2 Clinical Presentation
			11.c.2.3 Treatment of PTLD
			11.c.2.4 Outcomes
		11.c.3 PTLD After Lung and Heart–Lung Transplantation
			11.c.3.1 Epidemiology
			11.c.3.2 Clinical Presentation
			11.c.3.3 Treatment
			11.c.3.4 Outcome
		11.c.4 Take Home Pearls
		References
Chapter 11.d
	Posttransplant Lymphoproliferative Disease (PTLD) in Hematopoietic Stem Cell Transplantation (HSCT)
		11.d.1 Introduction
		11.d.2 Pathogenesis
		11.d.3 Definitions and Diagnosis of EBV Related Disease Post-HSCT
		11.d.4 Risk Factors
		11.d.5 Prevention and Treatment
			11.d.5.1 Prophylactic Therapy
			11.d.5.2 Preemptive Therapy
		11.d.6 Treatment of PTLD
		11.d.7 Take Home Pearls
		References
Chapter 12
	Research Priorities and Future Directions
		12.1 Introduction
		12.2 Etiology/Pathogenesis of PTLD
		12.3 Surveillance and Monitoring
		12.4 Treatment of PTLD
Index