University of Massachusetts Medical School Faculty Publications

Title

Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies

UMMS Affiliation

Department of Medicine, Division of Hematology/Oncology

Date

9-2013

Document Type

Article

Medical Subject Headings

Aged; Antineoplastic Agents; Antiviral Agents; Epstein-Barr Virus Infections; Humans; Immunosuppression; Immunotherapy; *Lymphoproliferative Disorders; Male; Organ Transplantation; Risk Factors; Transplantation, Homologous

Disciplines

Hematology | Hemic and Lymphatic Diseases | Oncology

Abstract

Post-transplant lymphoproliferative diseases (PTLD) are heterogeneous lymphoid disorders ranging from indolent polyclonal proliferations to aggressive lymphomas that complicate solid organ or hematopoietic transplantation. Risk factors for PTLD include viral infections, degree of immunosuppression, recipient age and race, allograft type, and host genetic variations. Clinically, extra-nodal disease is common including 10-15 % presenting with central nervous system (CNS) disease. Most PTLD cases are B cell (5-10 % T/NK cell or Hodgkin lymphoma), while over one-third are EBV-negative. World Health Organization (WHO) diagnostic categories are: early lesions, polymorphic, and monomorphic PTLD; although in practice, a clear separation is not always possible. Therapeutically, reduction in immunosuppression remains a mainstay, and recent data has documented the importance of rituximab +/- combination chemotherapy. Therapy for primary CNS PTLD should be managed according to immunocompetent CNS paradigms. Finally, novel treatment strategies for PTLD have emerged, including adoptive immunotherapy and rational targeted therapeutics (e.g., anti-CD30 based therapy and downstream signaling pathways of latent membrane protein-2A).

Rights and Permissions

Citation: Curr Hematol Malig Rep. 2013 Sep;8(3):173-83. doi: 10.1007/s11899-013-0162-5. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

23737188