Recent Advances in Adult Post-Transplant Lymphoproliferative Disorder

Abstract

PTLD is a rare but severe complication of hematopoietic or solid organ transplant recipients, with variable incidence and timing of occurrence depending on different patient-, therapy-, and transplant-related factors. The pathogenesis of PTLD is complex, with most cases of early PLTD having a strong association with Epstein-Barr virus (EBV) infection and the iatrogenic, immunosuppression-related decrease in T-cell immune surveillance. Without appropriate T-cell response, EBV-infected B cells persist and proliferate, resulting in malignant transformation. Classification is based on the histologic subtype and ranges from nondestructive hyperplasias to monoclonal aggressive lymphomas, with the most common subtype being diffuse large B-cell lymphoma-like PTLD. Management focuses on prevention of PTLD development, as well as therapy for active disease. Treatment is largely based on the histologic subtype. However, given lack of clinical trials providing evidence-based data on PLTD therapy-related outcomes, there are no specific management guidelines. In this review, we discuss the pathogenesis, histologic classification, and risk factors of PTLD. We further focus on common preventive and frontline treatment modalities, as well as describe the application of novel therapies for PLTD and elaborate on potential challenges in therapy.

Keywords: Epstein–Barr virus; immunotherapy; post-transplant lymphoproliferative disorder; rituximab; transplantation.

Figure 1

Pathogenesis and treatment algorithm of PLTD. Abbreviations: IST, immunosuppressive therapy; CIT, chemoimmunotherapy; DLBCL, diffuse large B-cell lymphoma; R/R, relapsed/refractory, CTLs, cytotoxic T-lymphocytes; HSCT, hematopoietic stem cell transplant; ADCs, Antibody Drug Conjugates; BV, Brentuximab Vedotin; 90YIT, 90 Yttrium ibritumomab tiuxetan; BTKi, Bruton Tyrosine Kinase Inhibitors; BiTE, Bispecific T cell Engagers; CAR, Chimeric Antigen Receptor.