Chapters authored
Post-Heart Transplantation Lymphoproliferations
Post-transplant lymphoproliferations (PTLDs) are the cancer with the highest incidence after cardiac transplantation. The World Health Organization (WHO) has defined several specific entities: clonal or non-clonal, early, polymorphic or monomorphic. Early PTLDs being generally positive for Epstein-Barr virus (EBV), preventive and preemptive treatments have been proposed; the former did not lead to effective attitudes, unlike preemptive treatment, based on EBV viral load monitoring the first year, which proposes a decrease of the immunosuppression with or without rituximab according to the viral load and the answer to the immunosuppression decrease. The curative treatment of CD20 positive PTLDs, the most frequent form, begins to be codified; it starts with a decrease in immunosuppression and then uses rituximab monotherapy and, depending on the response, either only rituximab or four courses of R-CHOP. By following this management, the incidence of early PTLDs decreases and the treatment of PTLDs provides survivals close to that of other transplant patients.
Part of the book: Heart Transplantation