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Important Considerations in the Diagnosis and Management of Post-transplant Lymphoproliferative Disorder

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Abstract

Purpose of Review

A relative lack of molecular and clinical studies compared to other lymphoid cancers has historically made it difficult to determine optimal management approaches in post-transplant lymphoproliferative disorder (PTLD). We sought to better define the “state of the science” in PTLD by examining recent advances in risk assessment, genomic profiling, and trials of PTLD-directed therapy.

Recent Findings

Several major clinical trials highlight risk-stratified sequential therapy incorporating rituximab with or without chemotherapy as a rational treatment strategy in patients with CD20+ PTLD who do not respond to reduction of immunosuppression alone. Epstein Barr virus (EBV)-targeted cytotoxic lymphocytes are a promising approach in patients with relapsed/refractory EBV+ PTLD, but dedicated clinical trials should determine how autologous chimeric antigen receptor T cell therapy (CAR-T) may be safely administered to PTLD patients.

Summary

Sequencing studies underscore the important effect of EBV infection on PTLD pathogenesis, but comprehensive genomic and tumor microenvironment profiling are needed to identify biomarkers that predict response to treatment in this clinically heterogeneous disease.

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Funding

This work was funded in part by the Lymphoma Research Foundation Career Development Award 611735 and by NIH/NCI 1R01CA266052.

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Authors and Affiliations

  1. Morehouse School of Medicine, Atlanta, GA, USA

    Michelle Lee

  2. Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Aseala Abousaud, Ellen Marin, Michael C. Churnetski & Jean L. Koff

  3. Emory University School of Medicine, Atlanta, GA, USA

    R. Andrew Harkins

  4. Georgia Institute of Technology, Atlanta, GA, USA

    Deepali Balasubramani & Ankur Singh

  5. Department of Pathology, Emory University, Atlanta, GA, USA

    Deniz Peker

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  1. Michelle Lee
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Correspondence to Jean L. Koff.

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Conflict of Interest

Michelle Lee, Aseala Abousaud, R. Andrew Harkins, Ellen Marin, Deepali Balasubramani, Michael C. Churnetski, Deniz Peker, and Ankur Singh declare no conflict of interest. Jean L. Koff has received clinical trial funding from Atara Biotherapeutics, Oncternal Therapeutics, and Viracta Therapeutics; received research funding from Viracta Therapeutics; and received compensation for service as a consultant from TG Therapeutics, Gamida Cell, MorphoSys, AbbVie, and BeiGene.

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Lee, M., Abousaud, A., Harkins, R.A. et al. Important Considerations in the Diagnosis and Management of Post-transplant Lymphoproliferative Disorder. Curr Oncol Rep 25, 883–895 (2023). https://doi.org/10.1007/s11912-023-01418-0

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