Treatment options in PTLD
| Treatment . | Target . | Advantages . | Disadvantages . |
|---|---|---|---|
| RIS | T-cell function | High response rates in early lesions Role in preemptive therapy | Takes time, so not feasible in very aggressive presentations Organ dependent Risk for organ rejection Less efficacy in HSCT |
| Cytokine therapy | T-cell function B-cell mass | Promising response rates | High toxicity (not further developed) |
| Donor lymphocyte infusion | T-cell function EBV | High response rates Rapidly available (at least in related donors) | Only in HSCT Unfavorable toxicity profile (graft-versus-host disease) |
| Adoptive immunotherapy (EBV-specific cytotoxic T cells) | T-cell function EBV | Promising results in refractory PTLD Excellent toxicity profile Rapidly developing field | Only in EBV+ cases Time consuming High costs Availability restrictions |
| Surgery and radiotherapy | B-cell mass | Rapid symptom relief | Only in limited-stage (stage I) disease Mostly palliative |
| Chemotherapy | B-cell mass | High response rates | High treatment-related morbidity and mortality |
| Rituximab | B-cell mass | High response rates Favorable toxicity profile Induces better performance state Allows risk stratification Role in preemptive therapy | Only in CD20+ PTLD Specific side effects (progressive multifocal leukoencephalopathy, hypogammaglobulinemia, hepatitis B reactivation) |
| Antiviral agents | EBV | Promising role in combination with viral thymidine kinase–inducing agents (eg, arginine butyrate) but not further developed | No efficacy in monotherapy (lack of viral thymidine kinase expression in EBV+ PTLD) Only in EBV+ cases |
| IV immunoglobulins | EBV | Theoretically attractive due to the presence of antibodies against EBV proteins | Mostly combined with other therapies; hence, no information on real efficacy |
| Treatment . | Target . | Advantages . | Disadvantages . |
|---|---|---|---|
| RIS | T-cell function | High response rates in early lesions Role in preemptive therapy | Takes time, so not feasible in very aggressive presentations Organ dependent Risk for organ rejection Less efficacy in HSCT |
| Cytokine therapy | T-cell function B-cell mass | Promising response rates | High toxicity (not further developed) |
| Donor lymphocyte infusion | T-cell function EBV | High response rates Rapidly available (at least in related donors) | Only in HSCT Unfavorable toxicity profile (graft-versus-host disease) |
| Adoptive immunotherapy (EBV-specific cytotoxic T cells) | T-cell function EBV | Promising results in refractory PTLD Excellent toxicity profile Rapidly developing field | Only in EBV+ cases Time consuming High costs Availability restrictions |
| Surgery and radiotherapy | B-cell mass | Rapid symptom relief | Only in limited-stage (stage I) disease Mostly palliative |
| Chemotherapy | B-cell mass | High response rates | High treatment-related morbidity and mortality |
| Rituximab | B-cell mass | High response rates Favorable toxicity profile Induces better performance state Allows risk stratification Role in preemptive therapy | Only in CD20+ PTLD Specific side effects (progressive multifocal leukoencephalopathy, hypogammaglobulinemia, hepatitis B reactivation) |
| Antiviral agents | EBV | Promising role in combination with viral thymidine kinase–inducing agents (eg, arginine butyrate) but not further developed | No efficacy in monotherapy (lack of viral thymidine kinase expression in EBV+ PTLD) Only in EBV+ cases |
| IV immunoglobulins | EBV | Theoretically attractive due to the presence of antibodies against EBV proteins | Mostly combined with other therapies; hence, no information on real efficacy |