What changed: Post-transplant lymphoproliferative disorder (PTLD)

When this page itself was last checked or edited.

Relapsed or refractory EBV-positive post-transplant lymphoproliferative disease after at least one prior therapy

First allogeneic T-cell immunotherapy approved; December 2022, for relapsed or refractory EBV-positive PTLD.

Reduce immunosuppression as far as graft safety allows, with close monitoring for rejection; surgery or radiotherapy for localised disease.

Rituximab weekly for four doses; patients in complete remission continue rituximab consolidation alone, others proceed to R-CHOP (PTLD-1 risk-stratified sequential treatment). (NCCN Category 2A)

Overall response 88 percent and complete remission 70 percent with risk-stratified sequential treatment; three-year response duration 82 percent; median overall survival 6.

Rituximab consolidation alone for complete responders (JCO 2017).

Weekly plasma EBV DNA monitoring with pre-emptive rituximab when load rises; reduction of immunosuppression where possible.

Trappe and colleagues, Lancet Oncology 2012.

Case series and the French multicentre trial (Blood 2006) establish anti-CD20 therapy.

Rooney, Heslop and colleagues (Lancet 1995) after stem cell transplant.

Hanto and colleagues show EBV in lymphoproliferations of transplant recipients and regression with reduced immunosuppression.

Doak and colleagues; Penn's registry (1969) establishes the association with immunosuppression.