Anti-B cell and anti-cytokine therapy for the treatment of post-transplant lymphoproliferative disorder: past, present, and future.

Abstract

Epstein-Barr virus (EBV)-induced post-transplant lymphoproliferative disorder (PTLD) is a rare but severe complication of solid organ and bone-marrow transplantation. When possible, reduction of immunosuppressive treatment or surgery for localized disease may cure PTLD. Therapeutic approaches using chemotherapy or antiviral drugs have limited effects on survival. Adoptive immunotherapy with donor T cell infusions has shown promising results in bone-marrow transplantation. The use of anti-B cell monoclonal antibodies is herein reported as a safe and efficient therapy for severe PTLD. Because IL6 has been described as a growth factor for EBV-infected B cells, anti-IL6 monoclonal antibody therapy was also tested in a phase I-II clinical trial, the results of which are summarized.