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Malignancy in pediatric transplant recipients.
Joseph F Buell1, Thomas G Gross, Mark J Thomas
1The Israel Penn International Transplant Tumor Registry, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio 45267, USA. joseph.buell@uc.edu
Seminars in Pediatric Surgery
|July 5, 2006
Summary
Post-transplant malignancies, including PTLD and solid cancers, are linked to immunosuppression. Reducing immunosuppression and using rituximab are key strategies, with new agents requiring further study.
Area of Science:
- Transplant medicine
- Oncology
- Immunology
Background:
- Malignancy is a known complication of chronic immunosuppression after organ transplantation.
- Post-transplant malignancies are associated with cumulative immunosuppression doses and viral infections in pediatric patients.
- Post Transplant Lymphoproliferative Disorder (PTLD) is the most common malignancy in this population, representing a disease continuum.
Purpose of the Study:
- To review the current understanding of post-transplant malignancies, focusing on PTLD and solid tumors.
- To discuss treatment strategies for PTLD, including immunosuppression reduction and novel therapies.
- To explore preventative measures and the oncologic potential of new immunosuppressive agents.
Main Methods:
- Literature review of post-transplant malignancies.
- Analysis of treatment outcomes for PTLD.
- Evaluation of strategies for malignancy prevention.
Main Results:
- PTLD is a spectrum of disease, with initial treatment involving immunosuppression reduction.
- Rituximab (anti-CD20 antibody) has become a preferred therapy over standard chemotherapy for PTLD.
- Solid malignancies (skin, gynecologic, rectal) are linked to chronic immunosuppression and viral mediators.
Conclusions:
- Management of PTLD involves immunosuppression adjustment and targeted therapies like rituximab.
- Preventative strategies include ganciclovir prophylaxis and specific maintenance immunosuppressants.
- New immunosuppressive agents require careful evaluation for their long-term oncologic risks.