Risk factors, diagnosis, and management of posttransplant lymphoproliferative disorder: improving patient outcomes with a multidisciplinary treatment approach

Kinga Ligeti, Lutz P Müller, Carsten Müller-Tidow, Thomas Weber Department of Hematology and Oncology, University Hospital Halle (Saale) and Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany Abstract: Posttransplant lymphoproliferative disease (PTLD) is a major complication after solid organ transplantation and allogeneic hematopoietic stem cell transplantation. The spectrum of PTLD ranges from benign hyperplasia to malignant lymphoma, representing one of the most relevant malignancies in these patients. Most PTLDs are driven by latent Epstein–Barr virus infections. The backbone of treatment is reduction of immunosuppression. Further treatment depends on the type of PTLD and the type of transplantation. A multidisciplinary approach involving transplant team, hematologists, and other disciplines is crucial for the diagnosis and treatment of PTLD and for concurrent preservation of the transplant function. In this study, known pathomechanisms, risk factors, preemptive management, and especially emerging treatment algorithms in PTLD were reviewed. Keywords: lymphoproliferative disease, Epstein-Barr virus, management, rituximab, ­preemptive therapy