1 / 12

Post Transplant Lymphoproliferative Disorders (PTLD)

Post Transplant Lymphoproliferative Disorders (PTLD). PTLD. PTLD is a group of lymphoproliferative disorders that range from hyperplasias to aggressive non-Hodgkin’s lymphoma PTLD is seen after both solid organ and stem cell transplant 90% of PTLDs are Ebstein-Barr Virus (EBV) positive.

persephone
Download Presentation

Post Transplant Lymphoproliferative Disorders (PTLD)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Post Transplant Lymphoproliferative Disorders(PTLD)

  2. PTLD • PTLD is a group of lymphoproliferative disorders that range from hyperplasias to aggressive non-Hodgkin’s lymphoma • PTLD is seen after both solid organ and stem cell transplant • 90% of PTLDs are Ebstein-Barr Virus (EBV) positive

  3. Incidence • PTLD occurs in 1% to 25% of solid organ transplant patients • PTLD occurs in < 2% of stem cell transplant patients • Incidence is 4 times higher in pediatric transplant patients versus adults

  4. Incidence by Type of Organ Transplanted • Intestinal transplant 18% • Lung 8% • Heart 3% • Liver 3% • Renal <1%

  5. Clinical Presentation • Some patients are asymptomatic • Others may have non specific symptoms • Fever • Malaise • Weight loss • May resemble infectious mononucleosis • Enlarged tonsils • Lymphadenopathy • Intestinal Perforation

  6. Systems Potentially Involved in PTLD • Central Nervous System • Bone Marrow • Kidneys • Liver • Lungs • Small intestines • Spleen

  7. Characterization • Early PTLD presents within one year following transplantation • 60% develop within one year • Late PTLD occurs more than one year post transplant • 30% develop within 1 to 5 years • 10% develop after 5 years

  8. Risk Factors • EBV seronegative recipient • Type of Organ transplanted • Type of immunosuppression • Simultaneous cytomegalovirus disease • Younger Age • Male

  9. Prevention/Monitoring • EBV Surveillance • Monitor EBV-DNA load • EBV vaccine • Not standard treatment • Anti-viral agents • Questionable value • Agents used include Acyclovir & Ganciclovir

  10. Treatment of PTLD • Reduction of Immunosuppression therapy • Anti-viral agents and IVIG are of limited value • Interferon alpha • Rituximab • CHOP • Doxorubicin, Cyclophosphamide, Vincristine and Prednisone

  11. Conclusion • Prognosis is poor • 5 year survival rates • 25 to 60% • High mortality rate • Lack of standard treatment

  12. References Bakker, N.A., van Imhoff, G.W., Verschuuren, E.A.M., & van Son, W. (2006). Presentation and early detection of post transplant lymphoproliferative disorder after solid organ transplantation.Transplant International, 20, 207-218 Everly, M.J., Bloom, R.D., Tsai, D.E. & Trofe, J. (2007). Posttransplant Lymphoproliferative Disorder. The Annals of Pharmacotherapy, 41, 1850-1858 Faye, A. & Vilmer, E. (2005). Post-Transplant Lymphoproliferative Disorder. Pediatric Drugs, 7, 1, 55-65 Gottschalk, S., Rooney, C.M., & Heslop, H.E. (2005). Post-Transplant Lymphoproliferative Disorders, 56, 29-44 Lee, J.J., Lam, M.S.H., & Rosenberg, A. (2007). Role of Chemotherapy and Rituximab for Treatment of Posttransplant Lymphoproliferative Disorder in Solid Organ Transplantation. The Annals of Pharmacotherapy, 41, 1648-1659 Shroff, R. & Rees, L. (2003). The post-transplant lymphoproliferative disorder – a literature review. Pediatric Nephrology, 19, 369 -377

More Related