Recent Advances in Adult Post-Transplant Lymphoproliferative Disorder

Abstract

PTLD is a rare but severe complication of hematopoietic or solid organ transplant recipients, with variable incidence and timing of occurrence depending on different patient-, therapy-, and transplant-related factors. The pathogenesis of PTLD is complex, with most cases of early PLTD having a strong association with Epstein–Barr virus (EBV) infection and the iatrogenic, immunosuppression-related decrease in T-cell immune surveillance. Without appropriate T-cell response, EBV-infected B cells persist and proliferate, resulting in malignant transformation. Classification is based on the histologic subtype and ranges from nondestructive hyperplasias to monoclonal aggressive lymphomas, with the most common subtype being diffuse large B-cell lymphoma-like PTLD. Management focuses on prevention of PTLD development, as well as therapy for active disease. Treatment is largely based on the histologic subtype. However, given lack of clinical trials providing evidence-based data on PLTD therapy-related outcomes, there are no specific management guidelines. In this review, we discuss the pathogenesis, histologic classification, and risk factors of PTLD. We further focus on common preventive and frontline treatment modalities, as well as describe the application of novel therapies for PLTD and elaborate on potential challenges in therapy.

Advances in Managing Infections in Lung Transplantation: A Review

“…Studies have previously suggested that early-onset PTLD portends a better prognosis, better response to reduced immunosuppression, and improved overall survival compared to late-onset PTLD [52]. The advent of the CD20 inhibitor, rituximab, has led to significantly improved remission rates in SOT recipients, with complete remission seen at 87% in patients treated with rituximab in kidney transplant recipients.…”

Post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients: Experience from a South African transplant center

“…12 In 2016, the World Health Organization classified PTLD into four major histological subtypes; namely early lesions, polymorphic and monomorphic PTLD, and classic Hodgkin-type lymphoma. 7,13 There are currently no definitive preventative strategies for PTLD, and prophylactic antivirals may only have a role during the early lytic stages of EBV infection. 14 The aim of this study was to determine the prevalence, complications, and associated factors for developing PTLD in South African PLT recipients.…”

“…The clinical spectrum of PTLD in children varies from being asymptomatic to disease presenting with florid symptoms including fever, diarrhea, and acute sepsis syndrome 12 . In 2016, the World Health Organization classified PTLD into four major histological subtypes; namely early lesions, polymorphic and monomorphic PTLD, and classic Hodgkin‐type lymphoma 7,13 …”

Genomic profiling of post-transplant lymphoproliferative disorders using cell-free DNA

“…Post-transplant lymphoproliferative disorder (PTLD) is a major complication after solid organ transplantation (SOT) [ 1 ]. While immunosuppressive therapy has been associated with early Epstein-Barr virus (EBV) driven PTLD, late-onset PTLD often lack EBV and have more genomic aberrations [ 2 – 4 ]. Diagnosis of PTLD is challenging due to its variable presentation.…”