Cancer-infection interface in children after transplantation: posttransplant lymphoproliferative disorder and Epstein-Barr virus infection.

PURPOSE OF REVIEW: To summarize the association between posttransplant lymphoproliferative disorder (PTLD), which is the most frequent cause of posttransplantation tumors in children, and Epstein-Barr virus (EBV) infection.

RECENT FINDINGS: Most PTLD cases present as proliferation of EBV-infected B cells, because EBV-naive patients have no EBV-specific cytotoxic lymphocytes to control the infected cells. The monitoring of EBV loads in whole blood, as well as in plasma by PCR, represents a useful method for early diagnosis and timely treatment. A program of EBV control by molecular EBV monitoring coupled with lymphocyte phenotype analysis is recommended. Pre-emptive reduced immunosuppression may prevent PTLD, and improved therapeutic options may also contribute to milder PTLD phenotype and improved clinical course.

SUMMARY: A recent trend is that PTLD incidence and high-grade histological findings have decreased because of appropriate immunosuppressive maintenance doses, monitoring of EBV, and preemptive treatment. More sensitive, specific tools for the detection of EBV replication and prophylactic methods are required to establish a definitive strategy for the prevention of PTLD after transplantation.