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Below, week by week, is what OnCo's record of Post-transplant lymphoproliferative disorder (PTLD) says about the first two months: the order is typical, the timing is yours to ask about. After an organ or stem cell transplant, the drugs that stop rejection also stop the immune system from policing Epstein-Barr virus, and infected B cells can grow into a lymphoma. The first move is to ease the immunosuppression; then the antibody rituximab, chemotherapy if needed, and, newest of all, off-the-shelf virus-specific T cells that restore the missing immune control. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Weekly plasma EBV DNA monitoring with pre-emptive rituximab when load rises; reduction of immunosuppression where possible.
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).
EBV-specific T cells: tabelecleucel (EMA approval 2022; under FDA review) or institutional virus-specific T-cell programmes; clinical trials.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.