What is Post-Transplant Lymphoproliferative Disorder (PTLD)?

The post-transplant lymphoproliferative disorders (PTLD) are a group of potentially life-threatening conditions that affect patients who have had an organ or bone marrow transplant.

PTLD occurs because the immune system of these patients is weakened to allow them to accept the newly transplanted organ or bone marrow.

• This weakened immune system is not very effective at removing certain viral infections such as the Epstein-Barr virus (EBV).
• It is also not always effective at watching for pre-cancer or cancer cells that may develop from long-term exposure to EBV. These abnormal cells often grow and can spread to other areas in the body.

Post-Transplant Lymphoproliferative Disorder (PTLD) Symptoms

The symptoms of PTLD depend on where in the body the disease begins, and how far it has spread when it is found.

A common symptom is painless swelling of the lymph nodes in the neck, armpit or groin. You may not notice an enlarged lymph node in the chest or belly until it is large enough to cause problems.

• If lymph nodes in the belly are infected, you may have pain, vomiting, diarrhea, constipation or weight loss.
• If lymph nodes in the neck or chest are affected, you may develop a cough, have trouble breathing or catching your breath, and may feel tired.

Post-Transplant Lymphoproliferative Disorder (PTLD) Diagnosis

If your doctor suspects PTLD, the first step is to do a physical exam and testing, which usually includes blood and radiology tests.

• Check for Epstein-Barr virus infection in the blood.
• A CT scan checks for PTLD in the neck, chest or belly.

If you have belly complaints, you may have an endoscopy or colonoscopy performed.

Other tests may help find out the extent of the disease and to see if it has spread through the lymph system to other parts of the body.

• Radioisotope scanning (PET scan) is useful to see if PTLD has spread to your liver, bones, bone marrow or spleen.
• You may need to have a bone marrow aspirate (taking out some fluid to test it) and biopsy (taking out some tissue to test it) if there is concern that the PTLD has spread to the bone marrow.
• Your doctor may perform a biopsy if they find a mass or enlarged lymph node. They remove the tissue and look at it under the microscope. They examine thin slices of the tissue for the presence, type, and arrangement of pre-cancer or cancer cells characteristic of the disease.

Post-Transplant Lymphoproliferative Disorder (PTLD) Treatment

Often the first line of treatment in PTLD is to reduce or completely stop the immunosuppression medicine that is causing the weakened immune system.

• Restoring the immune system to its normal function can be successful in treating PTLD.

Other treatment strategies may include:

• Chemotherapy: Strong medicines are given by mouth or through an IV (intravenously). These drugs target cells that are growing fast, as cancer cells do. Side effects are common because these strong drugs can also harm some normal cells.
• Biological / immunological therapy: Antibodies against the cancer cells are given. These may help the body’s immune system find and kill the bad cells, or they may help guide drugs or radiation directly to the cancer cells.
• Cyotoxic T-cell lymphocytes: Lymphocytes altered in the laboratory to target EBV-infected cells are infused into the patient with PTLD. They replicate and fight abnormal cells that are infected with EBV.