CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Post-transplantation Lymphoproliferative Disorder (PTLD): In the Liver Transplant Recipient.
Post-transplantation Lymphoproliferative Disorder (PTLD): In the Liver Transplant Recipient.
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移植后淋巴增殖性疾病(PTLD)是移植后时期并发的少见肿瘤。PTLD在肝移植后的发病率和结局描述较少。接受肝移植的儿童比成人有更高的PTLD风险。PTLD的危险因素包括免疫抑制水平和Epstein-Barr病毒状态。移植后患者的免疫抑制可导致B细胞不受控制地扩增。诊断需要高度的临床怀疑、影像学评估和组织活检。风险降低主要取决于减少患者接触侵袭性免疫抑制方案,并且是管理的初始步骤。利妥昔单抗联合或不联合化疗是主要治疗手段。对于难治性或持续性疾病,已探索了过继免疫治疗和自体干细胞移植等替代治疗方案。预后由PTLD的克隆性和疾病严重程度决定。
Post- transplantation lymphoproliferative disorders (PTLD) are uncommon neoplasms that complicate the post transplantation period. The incidence of PTLD and outcome post liver transplantation is sparsely described. Children who undergo liver transplantation are at higher risk of PTLD than adults. Risk factors for PTLD include the level of immunosuppression and Epstein-Barr virus status. Immunosuppression in post-transplant patients can cause uncontrolled expansion of B cells.
The diagnosis requires high degree of clinical suspicion, radiological evaluation, and tissue biopsy. Risk reduction depends mainly on decreasing patients' exposure to aggressive immunosuppressive regimens and is the initial step in management. Rituximab with or without chemotherapy is the mainstay of treatment. In refractory or persistent disease, alternative treatment options like adoptive immunotherapy and autologous stem cell transplant have been explored. Prognosis is determined by clonality of the PTLD and severity of the disease.
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