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Otolaryngologic management of posttransplant lymphoproliferative disease in children
1Department of Otolaryngology, New York University Medical Center, NY 10016.
Insights
Post-transplant lymphoproliferative disease (PTLD) in children often presents with head and neck symptoms, including upper airway obstruction. Early diagnosis and management, including reduced immunosuppression, are crucial for PTLD treatment.
Area of Science:
- Pediatric Oncology
- Transplantation Immunology
- Otolaryngology
Background:
- Post-transplant lymphoproliferative disease (PTLD) is a serious complication following organ or stem cell transplantation.
- Understanding the clinical presentation of PTLD in pediatric populations is essential for timely diagnosis and management.
Observation:
- A retrospective analysis of 14 children diagnosed with PTLD was conducted.
- Twelve of these children (86%) presented with head and neck symptoms, with upper airway obstruction being the most frequent (75%).
Findings:
- Common symptoms included febrile illnesses, dysphagia, odynophagia, and hypertrophy of Waldeyer's ring components (83%).
- Associated findings encompassed cervical adenopathy, sinusitis, and otitis media.
- Two children presented with intratracheal or paratracheal masses.
Implications:
- Surgical excision of obstructing lymphoid tissue is recommended for diagnosis and airway management.
- Systemic therapy, including reduction of immunosuppression, is vital for PTLD treatment.
- Erythromycin should be avoided in patients receiving cyclosporine due to potential drug interactions.
Abstract:
Twelve of 14 children (86%) given a pathologic diagnosis of posttransplantation lymphoproliferative disease (PTLD) at the Children's Hospital of Pittsburgh presented with head and neck symptoms, and are included in this retrospective analysis. Upper airway obstruction was the most common symptom, evident in nine children (75%). Ten children (83%) had febrile illnesses with dysphagia, odynophagia, and evidence of hypertrophy of components of Waldeyer's ring. Associated findings included cervical adenopathy, sinusitis, and otitis media. The two remaining children had an intratracheal and paratracheal mass, respectively. Excision of obstructing lymphoid tissue with proper handling of the specimen is advocated for diagnosis and relief of airway obstruction. Systemic therapy is necessary for treatment of PTLD and includes reduction of immunosuppression. Erythromycin causes elevation in cyclosporine levels and should be avoided in patients taking this drug.