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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 814973, 14 pages
http://dx.doi.org/10.1155/2013/814973
Review Article

Posttransplant Lymphoproliferative Disease after Pediatric Solid Organ Transplantation

1Department of Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany
2Integrated Research and Treatment Center Transplantation, Hannover Medical School, 30625 Hannover, Germany
3Dr. von Haunersches Kinderspital, Ludwig-Maximilians-University Munich, 80337 Munich, Germany
4Clinical Cooperation Group Pediatric Tumorimmunology, Children’s Hospital, University of Technology Munich, Helmholtz Center Munich, 80804 Munich, Germany

Received 6 May 2013; Revised 8 August 2013; Accepted 9 August 2013

Academic Editor: Luca Gattinoni

Copyright © 2013 Martin Mynarek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients after solid organ transplantation (SOT) carry a substantially increased risk to develop malignant lymphomas. This is in part due to the immunosuppression required to maintain the function of the organ graft. Depending on the transplanted organ, up to 15% of pediatric transplant recipients acquire posttransplant lymphoproliferative disease (PTLD), and eventually 20% of those succumb to the disease. Early diagnosis of PTLD is often hampered by the unspecific symptoms and the difficult differential diagnosis, which includes atypical infections as well as graft rejection. Treatment of PTLD is limited by the high vulnerability towards antineoplastic chemotherapy in transplanted children. However, new treatment strategies and especially the introduction of the monoclonal anti-CD20 antibody rituximab have dramatically improved outcomes of PTLD. This review discusses risk factors for the development of PTLD in children, summarizes current approaches to therapy, and gives an outlook on developing new treatment modalities like targeted therapy with virus-specific T cells. Finally, monitoring strategies are evaluated.