Transplantations-assoziierte Lymphoproliferationen

Der Pathologe (Impact Factor: 0.64). 03/2011; 32(2):152-158. DOI: 10.1007/s00292-010-1407-x

ABSTRACT Die Transplantation von soliden Organen und Knochenmark erfordert zur Verhinderung einer Abstoßungsreaktion eine medikamentöse
Immunsuppression, die dosis- und medikamentenabhängig die Entstehung von Epstein-Barr-Virus- (EBV-)assoziierten Posttransplantationslymphoproliferationen
(„post-transplant lymphoproliferative disease“, PTLD) begünstigt. Dabei gibt es ein Spektrum von Läsionen, die von der Hyperplasie
bis zum manifesten Lymphom reichen. Letzteres wird als monomorphe PTLD bezeichnet. Hyperplastische Veränderungen, die von
viralen Reaktionen nicht zu unterscheiden sind, werden als frühe oder Mononukleose-ähnliche Läsionen bezeichnet, solche, bei
denen die Lymphknotenarchitektur aufgehoben ist oder extranodale Herde entstehen, ohne dass ein lymphomartiger Phänotyp nachweisbar
ist, als polymorphe PTLD. Bei den monomorphen PTLD handelt es sich entweder um hochmaligne B-Zell-Lymphome, Plasmazellneoplasien
oder Hodgkin-Lymphome und nur sehr selten um T-Zell-Lymphome. Niedrig maligne B-Zell-Lymphome treten nicht auf. Eine Reduktion
der Immunsuppression kann bei einem Teil der Fälle einschließlich der monomorphen PTLD den Prozess zum Stillstand bringen.

Transplantation of solid organs and haematopoietic stem cells requires immunosuppressive drug therapy in order to prevent
rejection or graft-versus-host disease. Depending on dosage and type of drug, the risk of developing an Epstein-Barr virus
(EBV)-associated post-transplant lymphoproliferative disease (PTLD) is increased. The lesion spectrum ranges from hyperplastic
lesions to manifest lymphomas, the latter being classified as monomorphic PTLD. Hyperplastic changes, which are not distinguishable
from viral reactions, comprise early or mononucleosis-like lesions. Those with effaced lymph node architecture or extranodal
manifestation without a lymphoma-like phenotype are designated polymorphic PTLD. Monomorphic PTLD are either high grade B
cell lymphomas, plasma cell neoplasms or Hodgkin lymphomas and only very rarely T cell lymphomas. Low grade B cell lymphomas
do not occur. In a subfraction of cases, including even monomorphic PTLD, reduction of immunosuppression alone is sufficient
to induce remission of the pathological process.

KeywordsOrgan transplantation–Post-transplant lymphoproliferative disease–Epstein-Barr virus–Lymphoma–Immunosuppression

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