The Immunobiology of Post-Transplant Lymphoproliferative Disorders (PTLD)

  • Anne M. VanBuskirk
Chapter

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are actually a myriad of conditions in recipients of bone marrow or solid organ transplants, ranging from an infectious mononucleosis-like syndrome to frank lymphoma. At its worst, PTLD is an aggressive B-cell malignancy afflicting approximately 2-7% of all transplant patients. In this most severe form, PTLD can result in up to 50-90% mortality1-3. Typically, PTLD is of recipient origin in solid organ transplant recipients, and of donor origin in bone marrow transplant patients. Approximately 80% of PTLD occur within 18 months of transplantation. PTLD appear to progress from mononucleosis-like hyperplasia to oligoclonal lesions, then to polyclonal lesions, and ultimately to monoclonal lymphomas. If diagnosed early, some PTLD can be successfully treated with a reduction in immunosuppressionl, 24. PTLD occurring late after transplantation tend to be monoclonal lymphomas, and are much more difficult to treat, often requiring cessation of immunosuppression and chemotherapy5, 6. Most PTLD are B-cell lymphomas associated with Epstein—Barr virus (EBV)7. However, isolated cases of EBV-positive T-cell and NK-cell lymphomas have been reported8. In addition, EBV-negative PTLD appear to be increasing in incidence, particularly among PTLD arising late after transplantations, 6 The overall incidence of PTLD varies according to the type of organ transplanted. Adult kidney recipients tend to have the lowest overall incidence, with only 1-2% of transplant recipients being affected. In contrast, approximately 10-20% of combined heart and lung recipients develop PTLD1-3. Given the life-threatening nature of PTLD, it is considered a serious clinical problem in transplantation.

Keywords

Codon Leukemia Proline Oncol Sarcoma 

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Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Anne M. VanBuskirk
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State UniversityColumbusUSA

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