tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 6)

PCR can be used to monitor EBV production after hematopoietic stem cell transplantation. High or increasing viral loads predict an enhanced likelihood of developing EBV-LPD and should prompt rapid reduction of immunosuppression and search for a focus of disease. If reduction of immunosuppression does not have the desired effect, administration of a monoclonal antibody to CD20 (rituximab or others) for the treatment of B cell lymphomas that express this surface protein has elicited dramatic responses and currently constitutes first-line therapy for CD20-positive EBV-LPD. However, long-term suppression of new antibody responses accompanies therapy, and recurrences are not infrequent. Additional B. | Chapter 126. Infections in Transplant Recipients Part 6 PCR can be used to monitor EBV production after hematopoietic stem cell transplantation. High or increasing viral loads predict an enhanced likelihood of developing EBV-LPD and should prompt rapid reduction of immunosuppression and search for a focus of disease. If reduction of immunosuppression does not have the desired effect administration of a monoclonal antibody to CD20 rituximab or others for the treatment of B cell lymphomas that express this surface protein has elicited dramatic responses and currently constitutes first-line therapy for CD20-positive EBV-LPD. However long-term suppression of new antibody responses accompanies therapy and recurrences are not infrequent. Additional B cell-directed antibodies including anti-CD22 are under study. The role of antivirals is uncertain because no available agents have been documented to have activity against the different forms of latent EBV infection. Preventing lytic replication in these patients would theoretically produce a statistical decrease in the frequency of latent disease by decreasing the number of virions available to cause additional infection. In case reports and small animal studies ganciclovir and or high-dose zidovudine together with other agents has been used to eradicate EBV-LPD and CNS lymphomas another EBV-associated complication of transplantation. Both interferon and retinoic acid have been employed in the treatment of EBV-LPD as has IVIg but no large prospective studies have assessed the efficacy of any of these agents. Several additional drugs are undergoing preclinical evaluation. Standard chemotherapeutic regimens have been used as a last resort even though patients tolerance and long-term results have been disappointing. EBV-specific T cells generated from the donor have been used experimentally to prevent and to treat EBV-LPD in allogeneic recipients and efforts are under way to increase the activity and specificity of ex .

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• Infections in Transplant Recipients
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• bài giảng bệnh học
• tài liệu y khoa
• Harrisons Internal Medicine
• Transplant infections
• Specific sites of infection
• Bacterial infections
• Immunosuppressive agents
• Transplant Infections in developing countries
• Infections in kidney transplant recipients
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• Obstetrics
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• Preventing Morbidity
• Multidisciplinary Care