Abstract
The increased risk of malignancy, especially of lymphoid tumors, in solid-organ and hematopoietic stem cell transplant (HST) recipients has been recognized for many years [1-3]. Post-transplant lymphoproliferative disorder (PTLD) represents a heterogeneous group of abnormal lymphoid proliferations, generally of B-cell origin, that occur in the setting of ineffective T-cell function due to pharmacologic immunosuppression after organ transplantation. Unlike most other forms of non-Hodgkin’s lymphoma, nearly all PTLD is associated with Epstein-Barr virus (EBV) infection, as manifested by the presence of EBV within the malignant tissue.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Murray JE et al (1968) Five years’ experience in renal transplantation with immunosuppressive drugs: Survival, function, complications, and the role of lymphocyte depletion by thoracic duct fistula. Ann Surg 168(3):416-435
Penn I et al (1969) Malignant lymphomas in transplantation patients. Transplant Proc 1(1):106-112
Bhatia S et al (1996) Malignant neoplasms following bone marrow transplantation. Blood 87(9):3633-3639
Nalesnik MA (1996) Posttransplantation lymphoproliferative disorders (PTLD): Current perspectives. Semin Thorac Cardiovasc Surg 8(2):139-148
Frizzera G et al (1981) Polymorphic diffuse B-cell hyperplasias and lymphomas in renal transplant recipients. Cancer Res 41(11 Pt 1):4262-4279
Knowles DM et al (1995) Correlative morphologic and molecular genetic analysis demonstrates three distinct categories of posttransplantation lymphoproliferative disorders. Blood 85(2):552-565
Paya CV et al (1999) Epstein-Barr virus-induced posttransplant lymphoproliferative disorders. ASTS/ASTP EBV-PTLD Task Force and The Mayo Clinic Organized International Consensus Development Meeting. Transplantation 68(10):1517-1525
Harris NL, Ferry JA, Swerdlow SH (1997) Posttransplant lymphoproliferative disorders: Summary of Society for Hematopathology Workshop. Semin Diagn Pathol 14(1):8-14
Harris NL et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: Report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17(12):3835-3849
Harris NL et al (1994) A revised European-American classification of lymphoid neoplasms: A proposal from the International Lymphoma Study Group. Blood 84(5):1361-1392
Epstein MA, Achong BG, Barr YM (1964) Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet 1:702-703
Williams H, Crawford DH (2006) Epstein-Barr virus: The impact of scientific advances on clinical practice. Blood 107(3):862-869
Thorley-Lawson DA, Gross A (2004) Persistence of the Epstein-Barr virus and the origins of associated lymphomas. N Engl J Med 350(13):1328-1337
Zutter MM et al (1988) Epstein-Barr virus lymphoproliferation after bone marrow transplantation. Blood 72(2):520-529
Shapiro RS et al (1988) Epstein-Barr virus associated B cell lymphoproliferative disorders following bone marrow transplantation. Blood 71(5):1234-1243
Parry-Jones N et al (1999) Epstein-Barr virus (EBV) associated B-cell lymphoproliferative disease following HLA identical sibling marrow transplantation for aplastic anaemia in a patient with an EBV seronegative donor. Transplantation 67(10):1373-1375
Nalesnik MA, Makowka L, Starzl TE (1988) The diagnosis and treatment of posttransplant lymphoproliferative disorders. Curr Probl Surg 25(6):367-472
Opelz G, Dohler B (2004) Lymphomas after solid organ transplantation: A collaborative transplant study report. Am J Transplant 4(2):222-230
Katz BZ et al (2007) Case-control study of risk factors for the development of post-transplant lymphoproliferative disease in a pediatric heart transplant cohort. Pediatr Transplant 11(1):58-65
Penn I (2000) Post-transplant malignancy: The role of immunosuppression. Drug Saf 23(2):101-113
Nalesnik MA (1997) Clinicopathologic features of posttransplant lymphoproliferative disorders. Ann Transplant 2(4):33-40
Swinnen LJ et al (1990) Increased incidence of lymphoproliferative disorder after immunosuppression with the monoclonal antibody OKT3 in cardiac-transplant recipients. N Engl J Med 323(25):1723-1728
Bustami RT et al (2004) Immunosuppression and the risk of post-transplant malignancy among cadaveric first kidney transplant recipients. Am J Transplant 4(1):87-93
Gross TG et al (1999) B cell lymphoproliferative disorders following hematopoietic stem cell transplantation: Risk factors, treatment and outcome. Bone Marrow Transplant 23(3):251-258
Micallef IN et al (1998) Lymphoproliferative disorders following allogeneic bone marrow transplantation: The Vancouver experience. Bone Marrow Transplant 22(10):981-987
Curtis RE et al (1999) Risk of lymphoproliferative disorders after bone marrow transplantation: A multi-institutional study. Blood 94(7):2208-2216
Cohen JM et al (2007) EBV-related disease following haematopoietic stem cell transplantation with reduced intensity conditioning. Leuk Lymphoma 48(2):256-269
Herzig KA et al (2003) A single-centre experience of post-renal transplant lymphoproliferative disorder. Transpl Int 16(7):529-536
Barker JN et al (2001) Low incidence of Epstein-Barr virus-associated posttransplantation lymphoproliferative disorders in 272 unrelated-donor umbilical cord blood transplant recipients. Biol Blood Marrow Transplant 7(7):395-399
Hauke RJ et al (1998) Epstein-Barr virus-associated lymphoproliferative disorder after autologous bone marrow transplantation: Report of two cases. Bone Marrow Transplant 21(12):1271-1274
Shepherd JD et al (1995) Polyclonal Epstein-Barr virus-associated lymphoproliferative disorder following autografting for chronic myeloid leukemia. Bone Marrow Transplant 15(4):639-641
Lones MA et al (2000) Post-transplant lymphoproliferative disorder after autologous peripheral stem cell transplantation in a pediatric patient. Bone Marrow Transplant 26(9):1021-1024
Nash RA et al (2003) Epstein-Barr virus-associated posttransplantation lymphoproliferative disorder after high-dose immunosuppressive therapy and autologous CD34-selected hematopoietic stem cell transplantation for severe autoimmune diseases. Biol Blood Marrow Transplant 9(9):583-591
Crawford DH et al (1986) Epstein-Barr virus infection and immunity in bone marrow transplant recipients. Transplantation 42(1):50-54
Lucas KG et al (1996) The development of cellular immunity to Epstein-Barr virus after allogeneic bone marrow transplantation. Blood 87(6):2594-2603
Marshall NA et al (2000) Rapid reconstitution of Epstein-Barr virus-specific T lymphocytes following allogeneic stem cell transplantation. Blood 96(8):2814-2821
Small TN et al (1999) Comparison of immune reconstitution after unrelated and related T-cell-depleted bone marrow transplantation: Effect of patient age and donor leukocyte infusions. Blood 93(2):467-480
Leblond V et al (1998) Posttransplant lymphoproliferative disorders not associated with Epstein-Barr virus: A distinct entity? J Clin Oncol 16(6):2052-2059
Nelson BP et al (2000) Epstein-Barr virus-negative post-transplant lymphoproliferative disorders: A distinct entity? Am J Surg Pathol 24(3):375-385
Hezode C et al (1999) Role of hepatitis C virus in lymphoproliferative disorders after liver transplantation. Hepatology 30(3):775-778
McLaughlin K et al (2000) Increased risk for posttransplant lymphoproliferative disease in recipients of liver transplants with hepatitis C. Liver Transpl 6(5):570-574
Buda A et al (2000) Lymphoproliferative disorders in heart transplant recipients: Role of hepatitis C virus (HCV) and Epstein-Barr virus (EBV) infection. Transpl Int 13(Suppl 1):S402-S405
Morton LM et al (2007) Hepatitis C virus infection and risk of posttransplantation lymphoproliferative disorder among solid organ transplant recipients. Blood 110(13):4599-4605
Cockfield SM (2001) Identifying the patient at risk for post-transplant lymphoproliferative disorder. Transpl Infect Dis 3(2):70-78
Bakker NA et al (2007) Presentation and early detection of post-transplant lymphoproliferative disorder after solid organ transplantation. Transpl Int 20(3):207-218
Taylor AL, Marcus R, Bradley JA (2005) Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 56(1):155-167
Gottschalk S, Rooney CM, Heslop HE (2005) Post-transplant lymphoproliferative disorders. Annu Rev Med 56:29-44
Tsai DE et al (2001) Reduction in immunosuppression as initial therapy for posttransplant lymphoproliferative disorder: Analysis of prognostic variables and long-term follow-up of 42 adult patients. Transplantation 71(8):1076-1088
Kaleem Z et al (2004) Flow cytometric evaluation of posttransplant B-cell lymphoproliferative disorders. Arch Pathol Lab Med 128(2):181-186
Djokic M et al (2006) Post-transplant lymphoproliferative disorder subtypes correlate with different recurring chromosomal abnormalities. Genes Chromosomes Cancer 45(3):313-318
Poirel HA et al (2005) Characteristic pattern of chromosomal imbalances in posttransplantation lymphoproliferative disorders: Correlation with histopathological subcategories and EBV status. Transplantation 80(2):176-184
Vakiani E et al (2007) Cytogenetic analysis of B-cell posttransplant lymphoproliferations validates the World Health Organization classification and suggests inclusion of florid follicular hyperplasia as a precursor lesion. Hum Pathol 38(2):315-325
Tsai DE et al (2005) Serum protein electrophoresis abnormalities in adult solid organ transplant patients with post-transplant lymphoproliferative disorder. Clin Transplant 19(5):644-652
Benkerrou M, Durandy A, Fischer A (1993) Therapy for transplant-related lymphoproliferative diseases. Hematol Oncol Clin North Am 7(2):467-475
Benkerrou M et al (1998) Anti-B-cell monoclonal antibody treatment of severe posttransplant B-lymphoproliferative disorder: Prognostic factors and long-term outcome. Blood 92(9):3137-3147
Riddler SA, Breinig MC, McKnight JL (1994) Increased levels of circulating Epstein-Barr virus (EBV)-infected lymphocytes and decreased EBV nuclear antigen antibody responses are associated with the development of posttransplant lymphoproliferative disease in solid-organ transplant recipients. Blood 84(3):972-984
Savoie A et al (1994) Direct correlation between the load of Epstein-Barr virus-infected lymphocytes in the peripheral blood of pediatric transplant patients and risk of lymphoproliferative disease. Blood 83(9):2715-2722
Rooney CM et al (1995) Use of gene-modified virus-specific T lymphocytes to control Epstein-Barr-virus-related lymphoproliferation. Lancet 345(8941):9-13
Kenagy DN et al (1995) Epstein-Barr virus DNA in peripheral blood leukocytes of patients with posttransplant lymphoproliferative disease. Transplantation 60(6):547-554
Lucas KG et al (1998) Semiquantitative Epstein-Barr virus (EBV) polymerase chain reaction for the determination of patients at risk for EBV-induced lymphoproliferative disease after stem cell transplantation. Blood 91(10):3654-3661
McDiarmid SV et al (1998) Prevention and preemptive therapy of postransplant lymphoproliferative disease in pediatric liver recipients. Transplantation 66(12):1604-1611
Rooney CM et al (1995) Early identification of Epstein-Barr virus-associated post-transplantation lymphoproliferative disease. Br J Haematol 89(1):98-103
Green M et al (2000) Predictive negative value of persistent low Epstein-Barr virus viral load after intestinal transplantation in children. Transplantation 70(4):593-596
Tsai DE et al (2002) Use of EBV PCR for the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients. Am J Transplant 2(10):946-954
Yang J et al (2000) Characterization of Epstein-Barr virus-infected B cells in patients with posttransplantation lymphoproliferative disease: Disappearance after rituximab therapy does not predict clinical response. Blood 96(13):4055-4063
Kinch A et al (2007) Post-transplant lymphoproliferative disease and other Epstein-Barr virus diseases in allogeneic haematopoietic stem cell transplantation after introduction of monitoring of viral load by polymerase chain reaction. Scand J Infect Dis 39(3):235-244
van Esser JW et al (2002) Prevention of Epstein-Barr virus-lymphoproliferative disease by molecular monitoring and preemptive rituximab in high-risk patients after allogeneic stem cell transplantation. Blood 99(12):4364-4369
Wagner HJ et al (2004) Prompt versus preemptive intervention for EBV lymphoproliferative disease. Blood 103(10):3979-3981
Humar A, Michaels M (2006) American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant 6(2):262-274
Colby BM et al (1980) Effect of acyclovir [9-(2-hydroxyethoxymethyl)guanine] on Epstein-Barr virus DNA replication. J Virol 34(2):560-568
Crumpacker CS (1996) Ganciclovir. N Engl J Med 335(10):721-729
Faller DV, Mentzer SJ, Perrine SP (2001) Induction of the Epstein-Barr virus thymidine kinase gene with concomitant nucleoside antivirals as a therapeutic strategy for Epstein-Barr virus-associated malignancies. Curr Opin Oncol 13(5):360-367
Perrine SP et al (2007) A phase 1/2 trial of arginine butyrate and ganciclovir in patients with Epstein-Barr virus-associated lymphoid malignancies. Blood 109(6):2571-2578
Darenkov IA et al (1997) Reduced incidence of Epstein-Barr virus-associated posttransplant lymphoproliferative disorder using preemptive antiviral therapy. Transplantation 64(6):848-852
Davis CL et al (1995) Antiviral prophylaxis and the Epstein Barr virus-related post-transplant lymphoproliferative disorder. Clin Transplant 9(1):53-59
(2002) European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.6.2. Cancer risk after renal transplantation. Skin cancers: Prevention and treatment. Nephrol Dial Transplant 17 (Suppl 4):31-66
Davis CL et al (1998) Interferon-alpha treatment of posttransplant lymphoproliferative disorder in recipients of solid organ transplants. Transplantation 66(12):1770-1779
Dotti G et al (2002) Lymphomas occurring late after solid-organ transplantation: Influence of treatment on the clinical outcome. Transplantation 74(8):1095-1102
Koffman BH et al (2000) Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation. Int J Cancer 90(2):104-109
Hauke R et al (2001) Clinical and pathological features of posttransplant lymphoproliferative disorders: Influence on survival and response to treatment. Ann Oncol 12(6):831-834
Elstrom RL et al (2006) Treatment of PTLD with rituximab or chemotherapy. Am J Transplant 6(3):569-576
Kang SK, Kirkpatrick JP, Halperin EC (2003) Low-dose radiation for posttransplant lymphoproliferative disorder. Am J Clin Oncol 26(2):210-214
Starzl TE et al (1984) Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet 1(8377):583-587
Loren AW, Tsai DE (2005) Post-transplant lymphoproliferative disorder. Clin Chest Med 26(4):631-645 vii
Frey NV, Tsai DE (2007) The management of posttransplant lymphoproliferative disorder. Med Oncol 24(2):125-136
Shan D, Ledbetter JA, Press OW (1998) Apoptosis of malignant human B cells by ligation of CD20 with monoclonal antibodies. Blood 91(5):1644-1652
Di Gaetano N et al (2003) Complement activation determines the therapeutic activity of rituximab in vivo. J Immunol 171(3):1581-1587
Svoboda J, Kotloff R, Tsai DE (2006) Management of patients with post-transplant lymphoproliferative disorder: The role of rituximab. Transpl Int 19(4):259-269
Choquet S et al (2006) Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: Results of a prospective multicenter phase 2 study. Blood 107(8):3053-3057
Milpied N et al (2000) Humanized anti-CD20 monoclonal antibody (Rituximab) in post transplant B-lymphoproliferative disorder: A retrospective analysis on 32 patients. Ann Oncol 11(Suppl 1):113-116
Oertel SH et al (2005) Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant 5(12):2901-2906
Sharman JP et al (2006) Mature results of a prospective trial of rituximab in patients (Pt) with post transplant lymphoproliferative disorder (PTLD) unresponsive or ineligible for reduced immunosuppression (RIS). ASH Annu Meet Abstr 108(11):2755
Faye A et al (2001) Chimaeric anti-CD20 monoclonal antibody (rituximab) in post-transplant B-lymphoproliferative disorder following stem cell transplantation in children. Br J Haematol 115(1):112-118
Orjuela M et al (2003) A pilot study of chemoimmunotherapy (cyclophosphamide, prednisone, and rituximab) in patients with post-transplant lymphoproliferative disorder following solid organ transplantation. Clin Cancer Res 9(10 Pt 2):3945S-3952S
Faro A et al (1996) Interferon-alpha affects the immune response in post-transplant lymphoproliferative disorder. Am J Respir Crit Care Med 153(4 Pt 1):1442-1447
Tosato G et al (1993) Interleukin-6 production in posttransplant lymphoproliferative disease. J Clin Invest 91(6):2806-2814
Tosato G et al (1990) Identification of interleukin-6 as an autocrine growth factor for Epstein-Barr virus-immortalized B cells. J Virol 64(6):3033-3041
Haddad E et al (2001) Treatment of B-lymphoproliferative disorder with a monoclonal anti-interleukin-6 antibody in 12 patients: A multicenter phase 1-2 clinical trial. Blood 97(6):1590-1597
Swinnen LJ et al (1995) Aggressive treatment for postcardiac transplant lymphoproliferation. Blood 86(9):3333-3340
Mamzer-Bruneel MF et al (2000) Durable remission after aggressive chemotherapy for very late post-kidney transplant lymphoproliferation: A report of 16 cases observed in a single center. J Clin Oncol 18(21):3622-3632
Buell JF et al (2005) Chemotherapy for posttransplant lymphoproliferative disorder: The Israel Penn International Transplant Tumor Registry experience. Transplant Proc 37(2):956-957
Gross TG et al (2005) Low-dose chemotherapy for Epstein-Barr virus-positive post-transplantation lymphoproliferative disease in children after solid organ transplantation. J Clin Oncol 23(27):6481-6488
Oertel SH et al (2003) Salvage chemotherapy for refractory or relapsed post-transplant lymphoproliferative disorder in patients after solid organ transplantation with a combination of carboplatin and etoposide. Br J Haematol 123(5):830-835
Komrokji RS et al (2005) Mini-BEAM and autologous hematopoietic stem-cell transplant for treatment of post-transplant lymphoproliferative disorders. Am J Hematol 79(3):211-215
Bobey NA, Stewart DA, Woodman RC (2002) Successful treatment of posttransplant lymphoproliferative disorder in a renal transplant patient by autologous peripheral blood stem cell transplantation. Leuk Lymphoma 43(12):2421-2423
Kook H et al (1996) Reconstruction of the immune system after unrelated or partially matched T-cell-depleted bone marrow transplantation in children: Immunophenotypic analysis and factors affecting the speed of recovery. Blood 88(3):1089-1097
Kuzushima K et al (2000) Longitudinal dynamics of Epstein-Barr virus-specific cytotoxic T lymphocytes during posttransplant lymphoproliferative disorder. J Infect Dis 182(3):937-940
Khatri VP et al (1999) Endogenous CD8+ T cell expansion during regression of monoclonal EBV-associated posttransplant lymphoproliferative disorder. J Immunol 163(1):500-506
Porter DL, Orloff GJ, Antin JH (1994) Donor mononuclear cell infusions as therapy for B-cell lymphoproliferative disorder following allogeneic bone marrow transplant. Transplant Sci 4(1):12-14 discussion 14-6
Papadopoulos EB et al (1994) Infusions of donor leukocytes to treat Epstein-Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation. N Engl J Med 330(17):1185-1191
O'Reilly RJ et al (1997) Biology and adoptive cell therapy of Epstein-Barr virus-associated lymphoproliferative disorders in recipients of marrow allografts. Immunol Rev 157:195-216
Gustafsson A et al (2000) Epstein-Barr virus (EBV) load in bone marrow transplant recipients at risk to develop posttransplant lymphoproliferative disease: Prophylactic infusion of EBV-specific cytotoxic T cells. Blood 95(3):807-814
Rooney CM et al (1998) Infusion of cytotoxic T cells for the prevention and treatment of Epstein-Barr virus-induced lymphoma in allogeneic transplant recipients. Blood 92(5):1549-1555
Wagner HJ, Rooney CM, Heslop HE (2002) Diagnosis and treatment of posttransplantation lymphoproliferative disease after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 8(1):1-8
Gottschalk S et al (2001) An Epstein-Barr virus deletion mutant associated with fatal lymphoproliferative disease unresponsive to therapy with virus-specific CTLs. Blood 97(4):835-843
Nalesnik MA et al (1997) Autologous lymphokine-activated killer cell therapy of lymphoproliferative disorders arising in organ transplant recipients. Transplant Proc 29(3):1905-1906
Haque T et al (1998) Reconstitution of EBV-specific T cell immunity in solid organ transplant recipients. J Immunol 160(12):6204-6209
Haque T et al (2007) Allogeneic cytotoxic T-cell therapy for EBV-positive posttransplantation lymphoproliferative disease: Results of a phase 2 multicenter clinical trial. Blood 110(4):1123-1131
Gandhi MK et al (2007) Immunity, homing and efficacy of allogeneic adoptive immunotherapy for posttransplant lymphoproliferative disorders. Am J Transplant 7(5):1293-1299
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Reshef, R., Morgans, A.K., Tsai, D.E. (2010). Post-transplant Lymphoproliferative Disorder. In: Lazarus, H.M., Laughlin, M.J. (eds) Allogeneic Stem Cell Transplantation. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-478-0_34
Download citation
DOI: https://doi.org/10.1007/978-1-59745-478-0_34
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-934115-33-6
Online ISBN: 978-1-59745-478-0
eBook Packages: MedicineMedicine (R0)