The IPTA Nashville consensus conference on post‐transplant lymphoproliferative disorders after solid organ transplantation in children: IV‐consensus guidelines for the management of post‐transplant lymphoproliferative disorders in children and adolescents

Author:

Allen Upton D.1ORCID,L'Huillier Arnaud G.2ORCID,Bollard Catherine M.3,Gross Thomas G.4,Hayashi Robert J.5,Höcker Britta6,Maecker‐Kolhoff Britta7ORCID,Marks Stephen D.8,Mazariegos George Vincent910ORCID,Smets Francoise11,Trappe Ralf U.1213,Visner Gary14,Chinnock Richard E.15,Comoli Patrizia16,Danziger‐Isakov Lara17ORCID,Dulek Daniel E.18ORCID,Dipchand Anne I.19ORCID,Ferry Judith A.20,Martinez Olivia M.21,Metes Diana M.22,Michaels Marian G.23,Preiksaitis Jutta24,Squires James E.25ORCID,Swerdlow Steven H.26,Wilkinson James D.27ORCID,Dharnidharka Vikas R.28ORCID,Green Michael23ORCID,Webber Steven A.27,Esquivel Carlos O.29

Affiliation:

1. Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Center, Hospital for Sick Children University of Toronto Toronto Ontario Canada

2. Pediatric Infectious Diseases Unit and Laboratory of Virology Geneva University Hospitals and Faculty of Medicine Geneva Switzerland

3. Center for Cancer and Immunology Research, Children's National Hospital The George Washington University Washington District of Columbia USA

4. Center for Cancer and Blood Diseases Children's Hospital Colorado Aurora Colorado USA

5. Division of Pediatric Hematology/Oncology, St. Louis Children's Hospital Washington University School of Medicine St. Louis Missouri USA

6. Department of Pediatrics I, Medical Faculty, University Children's Hospital Heidelberg University Heidelberg Germany

7. Hannover Medical School, Pediatric Hematology and Oncology Hannover Germany

8. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust NIHR Great Ormond Street Hospital Biomedical Research Centre London UK

9. Hillman Center for Pediatric Transplantation UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA

10. Department of Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

11. Pediatric Gastroenterology and Hepatology Cliniques Universitaires Saint‐Luc, UCLouvain Brussels Belgium

12. Department of Hematology and Oncology DIAKO Ev. Diakonie‐Krankenhaus Bremen Bremen Germany

13. Department of Internal Medicine II: Hematology and Oncology University Medical Centre Schleswig‐Holstein Kiel Germany

14. Division of Pulmonary Medicine Boston Children's Hospital/Harvard Medical School Boston Massachusetts USA

15. Loma Linda University Children's Hospital Loma Linda California USA

16. Cell Factory & Pediatric Hematology/Oncology Fondazione IRCCS Policlinico San Matteo Pavia Italy

17. Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio USA

18. Division of Pediatric Infectious Diseases Monroe Carell Junior Children's Hospital at Vanderbilt and Vanderbilt University Medical Center Nashville Tennessee USA

19. Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children University of Toronto Toronto Ontario Canada

20. Harvard Medical School Massachusetts General Hospital Boston Massachusetts USA

21. Department of Surgery and Program in Immunology Stanford University School of Medicine Stanford California USA

22. Thomas E. Starzl Transplantation Institute University of Pittsburgh Pittsburgh Pennsylvania USA

23. Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

24. Division of Infectious Diseases, Department of Medicine University of Alberta Edmonton Alberta Canada

25. Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

26. Department of Pathology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

27. Department of Pediatrics Vanderbilt School of Medicine Nashville Tennessee USA

28. Division of Pediatric Nephrology, Hypertension & Apheresis, Department of Pediatrics Washington University School of Medicine and St. Louis Children's Hospital St. Louis Missouri USA

29. Stanford University School of Medicine Stanford California USA

Abstract

AbstractThe International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post‐transplant lymphoproliferative disorders (PTLD) after pediatric solid organ transplantation. This report addresses the outcomes of deliberations by the PTLD Management Working Group. A strong recommendation was made for reduction in immunosuppression as the first step in management. Similarly, strong recommendations were made for the use of the anti‐CD20 monoclonal antibody (rituximab) as was the case for chemotherapy in selected scenarios. In some scenarios, there is uncoupling of the strength of the recommendations from the available evidence in situations where such evidence is lacking but collective clinical experiences drive decision‐making. Of note, there are no large, randomized phase III trials of any treatment for PTLD in the pediatric age group. Current gaps and future research priorities are highlighted.

Funder

School of Medicine, Vanderbilt University

Washington University School of Medicine in St. Louis

Hospital for Sick Children

Medical Center, University of Pittsburgh

Publisher

Wiley

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