Medscape is available in 5 Language Editions – Choose your Edition here.


Posttransplant Lymphoproliferative Disease Medication

  • Author: Phillip M Garfin, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
Updated: Apr 09, 2015

Medication Summary

Immunosuppressive agents are often an important part of graft maintenance and posttransplant care. Nevertheless, when faced with posttransplant lymphoproliferative disease (PTLD), it is important to reduce or modify the immunosuppressive regimen if at all possible. Because of the complexity and variety of immunosuppressive regimens, there are no standard approaches to achieve this reduction in immunosuppression. It is left to the combined judgement of the transplanting and PTLD-treating physicians. Any reduction in immunosuppression warrants close monitoring for the possibility of allograft dysfunction or rejection.


Immunosuppressive Agents

Class Summary

These agents inhibit key factors that mediate immune reactions, which, in turn. decrease inflammatory responses.

Cyclosporine (Sandimmune, Neoral)


Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft versus host disease for a variety of organs.

For children and adults, base dosing on ideal body weight.

Tacrolimus (Prograf)


Tacrolimus suppresses humoral immunity (T-lymphocyte) activity.

Mycophenolate (CellCept)


Mycophenolate inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. It inhibits antibody production.

Prednisone (Deltasone, Orasone, Meticorten, Sterapred)


Prednisone is used as an immunosuppressive, anti-inflammatory agent and as a component of both CHOP and ProMACE-CytaBOM chemotherapeutic regimens, which have been used to treat PTLD.

It may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. It stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.


Antiviral Agents

Class Summary

These are nucleoside analogs phosphorylated by viral thymidine kinase to form a nucleoside triphosphate. These nucleoside triphosphates inhibit herpes simplex virus (HSV) polymerase with 30-50 times more than they inhibit human alpha-DNA polymerase.

Acyclovir (Zovirax)


Acyclovir inhibits activity of both HSV-1 and HSV-2. It has affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase.

It is routinely used to treat infections with HSV, mainly HSV-1 and HSV-2. EBV also is a herpes virus, but its use as prophylaxis against and treatment for EBV-related illness posttransplantation is controversial. If used for these purposes, doses and duration of treatment are variable and are determined by the clinician.

Ganciclovir (Cytovene)


Ganciclovir is a synthetic guanine derivative active against CMV. It is an acyclic nucleoside analog of 2'-deoxyguanosine that inhibits replication of herpes viruses both in vitro and in vivo.

Levels of ganciclovir-triphosphate are as much as 100-fold greater in CMV-infected cells than in uninfected cells, possibly due to preferential phosphorylation of ganciclovir in virus-infected cells.

For patients who experience progression of CMV retinitis while receiving a maintenance treatment with either dosage form of ganciclovir, the re-induction regimen should be administered.


Immunomodulator Agents

Class Summary

Rituximab (anti-CD20 monoclonal antibody) has successfully treated PTLD. Other monoclonal antibodies, such as anti-CD21, CD24, and immunomodulatory agents such as interferon alfa have also been used in the treatment of PTLD.

Rituximab (Rituxan)


Rituximab is an antibody genetically engineered. It is a chimeric murine/human monoclonal antibody directed against the CD20 antigen found on surface of normal and malignant B lymphocytes. The antibody is an IgG1 kappa immunoglobulin containing murine light- and heavy-chain variable region sequences and human constant region sequences.

Immune globulin intravenous (Gamimune, Gammagard S/D, Sandoglobulin)


Immune globulin intravenous neutralizes circulating myelin antibodies through anti-idiotypic antibodies. It down-regulates proinflammatory cytokines, including INF-gamma. It blocks Fc receptors on macrophages. It suppresses inducer T and B cells and augments suppressor T cells. It blocks the complement cascade, promotes remyelination, and may increase CSF IgG (10%).

Interferon alfa-2b (Intron A)


Interferon alfa-2b is a protein product manufactured by recombinant DNA technology. The mechanism of antitumor activity is not understood clearly; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.

Doses and duration of treatment are as determined by the involved clinicians.


Antineoplastic Agents

Class Summary

These agents disrupt DNA replication or cell division, inhibiting cell growth and proliferation. Prednisone (listed above) also can be included in this category.

Cyclophosphamide (Cytoxan, Neosar)


Cyclophosphamide is chemically related to nitrogen mustards. As an alkylating agent, the mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. It is a component of CHOP and ProMACE-CytaBOM chemotherapeutic regimens.

Doxorubicin (Adriamycin, Rubex)


Doxorubicin inhibits topoisomerase II and produces free radicals, which may cause the destruction of DNA. The combination of these 2 events can, in turn, inhibit the growth of neoplastic cells. It is a component of the CHOP and ProMACE-CytaBOM chemotherapeutic regimens.

Vincristine (Oncovin, Vincasar PFS)


Vincristine's mechanism of action is uncertain. It may involve a decrease in reticuloendothelial cell function or an increase in platelet production. However, neither of these mechanisms would fully explain the effect in thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome. It is a component of the CHOP and ProMACE-CytaBOM chemotherapeutic regimens.

Etoposide (Toposar, VePesid)


Etoposide inhibits topoisomerase II and causes DNA strand breakage, causing cell proliferation to arrest in late S or early G2 portion of the cell cycle. It is a component of the ProMACE-CytaBOM regimen.

Bleomycin (Blenoxane)


Bleomycin is a glycopeptide antibiotic that inhibits DNA synthesis. It is used as a palliative measure in the management of several neoplasms. It is a component of the ProMACE-CytaBOM regimen.

Methotrexate (Folex PFS, Rheumatrex)


Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction in malignant cells. Satisfactory response is observed 3-6 weeks following administration. Adjust the dose gradually to attain a satisfactory response. It is a component of the ProMACE-CytaBOM regimen.

Fludarabine (Fludara, Oforta)


Fludarabine is a purine analog can be given PO or IV. It interferes with ribonucleotide reductase and DNA polymerase. It is active against both resting and dividing cells.

Contributor Information and Disclosures

Phillip M Garfin, MD, PhD California Institute of Regenerative Medicine MD Training Scholar, Clinical Instructor, Section of Hematology, Oncology, Stem Cell Transplantation, and Cancer Biology, Department of Pediatrics, Stanford University School of Medicine

Phillip M Garfin, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.


Clare J Twist, MD Associate Professor of Pediatrics, Division of Hematology/Oncology, Medical Center Line, Stanford University School of Medicine; Medical Staff, Lucile Packard Children’s Hospital and Stanford University Medical Center

Clare J Twist, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, SWOG

Disclosure: Partner received none from No financial interests for none.

Chief Editor

Ron Shapiro, MD Professor of Surgery, Robert J Corry Chair in Transplantation Surgery, Associate Clinical Director, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center

Ron Shapiro, MD is a member of the following medical societies: American Society of Transplantation, American Surgical Association, American College of Surgeons, Transplantation Society, International Pediatric Transplant Association, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, Society of University Surgeons

Disclosure: Nothing to disclose.


Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Mary Prendergast, MD Department of Internal Medicine, University of Nebraska Medical Center

Mary Prendergast, MD is a member of the following medical societies: Royal College of Physicians

Disclosure: Nothing to disclose.

Vinay Ranga, MD Assistant Professor, Department of Internal Medicine, Division of Nephrology, Hartford Hospital

Disclosure: Nothing to disclose.

  1. Green M, Webber S. Posttransplantation lymphoproliferative disorders. Pediatr Clin North Am. 2003 Dec. 50(6):1471-91. [Medline].

  2. Swerdlow SH, Webber SA, Chadburn A, Ferry JA. Posttransplant lymphoproliferative disorders. Swerdlow SH, Campo E, Harris NL, Jaffe ES. WHO classification of tumors of haemotopoietic and lymphoid tissue. IARC, Lyon; 2008. 343-350.

  3. Glotz D, Chapman JR, Dharnidharka VR, Hanto DW, Castro MC, Hirsch HH, et al. The Seville Expert Workshop for Progress in Posttransplant Lymphoproliferative Disorders. Transplantation. 2012 Sep 18. [Medline].

  4. Bakker NA, van Imhoff GW. Post-transplant lymphoproliferative disorders: from treatment to early detection and prevention?. Haematologica. 2007 Nov. 92(11):1447-50. [Medline].

  5. Capello D, Berra E, Cerri M, Gaidano G. Post-transplant lymphoproliferative disorders. Molecular analysis of histogenesis and pathogenesis. Minerva Med. 2004 Feb. 95(1):53-64. [Medline].

  6. Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000 Aug 17. 343(7):481-92. [Medline].

  7. Henle G, Henle W, Diehl V. Relation of Burkitt's tumor-associated herpes-type virus to infectious mononucleosis. Proc Natl Acad Sci U S A. 1968 Jan. 59(1):94-101. [Medline].

  8. Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt's lymphoma. Lancet. 1964. 1:702-3.

  9. Greenspan JS, Greenspan D, Lennette ET. Replication of Epstein-Barr virus within the epithelial cells of oral "hairy" leukoplakia, an AIDS-associated lesion. N Engl J Med. 1985 Dec 19. 313(25):1564-71. [Medline].

  10. zur Hausen H, Schulte-Holthausen H, Klein G, et al. EBV DNA in biopsies of Burkitt tumours and anaplastic carcinomas of the nasopharynx. Nature. 1970 Dec 12. 228(276):1056-8. [Medline].

  11. Cen H, Williams PA, McWilliams HP, et al. Evidence for restricted Epstein-Barr virus latent gene expression and anti-EBNA antibody response in solid organ transplant recipients with posttransplant lymphoproliferative disorders. Blood. 1993 Mar 1. 81(5):1393-403. [Medline].

  12. Shaknovich R, Basso K, Bhagat G, et al. Identification of rare Epstein-Barr virus infected memory B cells and plasma cells in non-monomorphic post-transplant lymphoproliferative disorders and the signature of viral signaling. Haematologica. 2006 Oct. 91(10):1313-20. [Medline].

  13. D'Antiga L, Del Rizzo M, Mengoli C, Cillo U, Guariso G, Zancan L. Sustained Epstein-Barr virus detection in paediatric liver transplantation. Insights into the occurrence of late PTLD. Liver Transpl. 2007 Mar. 13(3):343-8. [Medline].

  14. Cox KL, Lawrence-Miyasaki LS, Garcia-Kennedy R. An increased incidence of Epstein-Barr virus infection and lymphoproliferative disorder in young children on FK506 after liver transplantation. Transplantation. 1995 Feb 27. 59(4):524-9. [Medline].

  15. Swinnen LJ, LeBlanc M, Grogan TM, Gordon LI, Stiff PJ, Miller AM. Prospective study of sequential reduction in immunosuppression, interferon alpha-2B, and chemotherapy for posttransplantation lymphoproliferative disorder. Transplantation. 2008 Jul 27. 86(2):215-22. [Medline].

  16. Ziegler JL, Drew WL, Miner RC, et al. Outbreak of Burkitt's-like lymphoma in homosexual men. Lancet. 1982 Sep 18. 2(8299):631-3. [Medline].

  17. Schubert S, Renner C, Hammer M, Abdul-Khaliq H, Lehmkuhl HB, Berger F. Relationship of immunosuppression to Epstein-Barr viral load and lymphoproliferative disease in pediatric heart transplant patients. J Heart Lung Transplant. 2008 Jan. 27(1):100-5. [Medline].

  18. Knowles DM, Cesarman E, Chadburn A. Correlative morphologic and molecular genetic analysis demonstrates three distinct categories of posttransplantation lymphoproliferative disorders. Blood. 1995 Jan 15. 85(2):552-65. [Medline].

  19. LaCasce AS. Post-transplant lymphoproliferative disorders. Oncologist. 2006 Jun. 11(6):674-80. [Medline].

  20. Gottschalk S, Rooney CM, Heslop HE. Post-transplant lymphoproliferative disorders. Annu Rev Med. 2004 Aug 11.

  21. Caillard S, Lamy FX, Quelen C, Dantal J, Lebranchu Y, Lang P. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas. Am J Transplant. 2012 Mar. 12(3):682-93. [Medline].

  22. Dharnidharka VR, Lamb KE, Gregg JA, Meier-Kriesche HU. Associations between EBV serostatus and organ transplant type in PTLD risk: an analysis of the SRTR National Registry Data in the United States. Am J Transplant. 2012 Apr. 12(4):976-83. [Medline].

  23. Jamali FR, Otrock ZK, Soweid AM, Al-Awar GN, Mahfouz RA, Haidar GR. An overview of the pathogenesis and natural history of post-transplant T-cell lymphoma. Leuk Lymphoma. 2007 Jun. 48(6):1237-41. [Medline].

  24. Ghobrial I, Habermann T, Ristow K, et al. Prognostic factors in patients with post-transplant lymphoproliferative disorders (PTLD) in the rituximab era. Leuk Lymphoma. 2005 Feb. 46(2):191-6. [Medline].

  25. Sampaio MS, Cho YW, Qazi Y, Bunnapradist S, Hutchinson IV, Shah T. Posttransplant malignancies in solid organ adult recipients: an analysis of the U.S. National Transplant Database. Transplantation. 2012 Nov 27. 94(10):990-8. [Medline].

  26. McDonald RA, Smith JM, Ho M, Lindblad R, Ikle D, Grimm P. Incidence of PTLD in pediatric renal transplant recipients receiving basiliximab, calcineurin inhibitor, sirolimus and steroids. Am J Transplant. 2008 May. 8(5):984-9. [Medline].

  27. Cleper R, Ben Shalom E, Landau D, Weissman I, Krause I, Konen O. Post-transplantation lymphoproliferative disorder in pediatric kidney-transplant recipients - a national study. Pediatr Transplant. 2012 Sep. 16(6):619-26. [Medline].

  28. Draoua HY, Tsao L, Mancini DM, et al. T-cell post-transplantation lymphoproliferative disorders after cardiac transplantation: a single institutional experience. Br J Haematol. 2004 Nov. 127(4):429-32. [Medline].

  29. Kremers WK, Devarbhavi HC, Wiesner RH, Krom RA, Macon WR, Habermann TM. Post-transplant lymphoproliferative disorders following liver transplantation: incidence, risk factors and survival. Am J Transplant. 2006 May. 6(5 Pt 1):1017-24. [Medline].

  30. Cao S, Cox KL, Berquist W, Hayashi M, Concepcion W, Hammes GB. Long-term outcomes in pediatric liver recipients: comparison between cyclosporin A and tacrolimus. Pediatr Transplant. 1999 Feb. 3(1):22-6. [Medline].

  31. Kremer BE, Reshef R, Misleh JG, Christie JD, Ahya VN, Blumenthal NP. Post-transplant lymphoproliferative disorder after lung transplantation: a review of 35 cases. J Heart Lung Transplant. 2012 Mar. 31(3):296-304. [Medline].

  32. Jagadeesh D, Woda BA, Draper J, Evens AM. Post transplant lymphoproliferative disorders: risk, classification, and therapeutic recommendations. Curr Treat Options Oncol. 2012 Mar. 13(1):122-36. [Medline].

  33. Hauke R, Smir B, Greiner T. Clinical and pathological features of posttransplant lymphoproliferative disorders: influence on survival and response to treatment. Ann Oncol. 2001 Jun. 12(6):831-4. [Medline].

  34. Leblond V, Dhedin N, Mamzer Bruneel MF, et al. Identification of prognostic factors in 61 patients with posttransplantation lymphoproliferative disorders. J Clin Oncol. 2001 Feb 1. 19(3):772-8. [Medline].

  35. Meerbach A, Wutzler P, Häfer R, Zintl F, Gruhn B. Monitoring of Epstein-Barr virus load after hematopoietic stem cell transplantation for early intervention in post-transplant lymphoproliferative disease. J Med Virol. 2008 Mar. 80(3):441-54. [Medline].

  36. Lee TC, Savoldo B, Rooney CM, Heslop HE, Gee AP, Caldwell Y. Quantitative EBV viral loads and immunosuppression alterations can decrease PTLD incidence in pediatric liver transplant recipients. Am J Transplant. 2005 Sep. 5(9):2222-8. [Medline].

  37. Riddler SA, Breinig MC, McKnight JL. Increased levels of circulating Epstein-Barr virus (EBV)-infected lymphocytes and decreased EBV nuclear antigen antibody responses are associated with the development of posttransplant lymphoproliferative disease in solid-organ transplant recipients. Blood. 1994 Aug 1. 84(3):972-84. [Medline].

  38. Buell JF, Gross TG, Hanaway MJ, Trofe J, Muthiak C, First MR. Chemotherapy for posttransplant lymphoproliferative disorder: the Israel Penn International Transplant Tumor Registry experience. Transplant Proc. 2005 Mar. 37(2):956-7. [Medline].

  39. Hanson MN, Morrison VA, Peterson BA, et al. Posttransplant T-cell lymphoproliferative disorders--an aggressive, late complication of solid-organ transplantation. Blood. 1996 Nov 1. 88(9):3626-33. [Medline].

  40. Benkerrou M, Jais JP, Leblond V, et al. Anti-B-cell monoclonal antibody treatment of severe posttransplant B- lymphoproliferative disorder: prognostic factors and long-term outcome. Blood. 1998 Nov 1. 92(9):3137-47. [Medline].

  41. Faro A, Kurland G, Michaels MG, et al. Interferon-alpha affects the immune response in post-transplant lymphoproliferative disorder. Am J Respir Crit Care Med. 1996 Apr. 153(4 Pt 1):1442-7. [Medline].

  42. Shapiro RS, Chauvenet A, McGuire W, et al. Treatment of B-cell lymphoproliferative disorders with interferon alfa and intravenous gamma globulin. N Engl J Med. 1988 May 19. 318(20):1334. [Medline].

  43. O'Brien S, Bernert RA, Logan JL, Lien YH. Remission of posttransplant lymphoproliferative disorder after interferon alfa therapy. J Am Soc Nephrol. 1997 Sep. 8(9):1483-9. [Medline].

  44. Fischer A, Blanche S, Le Bidois J, et al. Anti-B-cell monoclonal antibodies in the treatment of severe B-cell lymphoproliferative syndrome following bone marrow and organ transplantation. N Engl J Med. 1991 May 23. 324(21):1451-6. [Medline].

  45. Milpied N, Vasseur B, Parquet N, et al. Humanized anti-CD20 monoclonal antibody (Rituximab) in post transplant B-lymphoproliferative disorder: a retrospective analysis on 32 patients. Ann Oncol. 2000. 11 Suppl 1:113-6. [Medline].

  46. Papadopoulos EB, Ladanyi M, Emanuel D. Infusions of donor leukocytes to treat Epstein-Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation. N Engl J Med. 1994 Apr 28. 330(17):1185-91. [Medline].

  47. Cruz RJ Jr, Ramachandra S, Sasatomi E, Dimartini A, de Vera M, Fontes P, et al. Surgical management of gastrointestinal posttransplant lymphoproliferative disorders in liver transplant recipients. Transplantation. 2012 Aug 27. 94(4):417-23. [Medline].

  48. Becker YT, Samaniego-Picota M, Sollinger HW. The emerging role of rituximab in organ transplantation. Transpl Int. 2006 Aug. 19(8):621-8. [Medline].

  49. González-Barca E, Domingo-Domenech E, Capote FJ, Gómez-Codina J, Salar A, Bailen A. Prospective phase II trial of extended treatment with rituximab in patients with B-cell post-transplant lymphoproliferative disease. Haematologica. 2007 Nov. 92(11):1489-94. [Medline].

  50. Taj MM, Messahel B, Mycroft J, Pritchard-Jones K, Baker A, Height S. Efficacy and tolerability of high-dose methotrexate in central nervous system positive or relapsed lymphoproliferative disease following liver transplant in children. Br J Haematol. 2008 Jan. 140(2):191-6. [Medline].

  51. Bollard CM, Rooney CM, Heslop HE. T-cell therapy in the treatment of post-transplant lymphoproliferative disease. Nat Rev Clin Oncol. 2012 Sep. 9(9):510-9. [Medline].

  52. Doubrovina E, Oflaz-Sozmen B, Prockop SE, Kernan NA, Abramson S, Teruya-Feldstein J. Adoptive immunotherapy with unselected or EBV-specific T cells for biopsy-proven EBV+ lymphomas after allogeneic hematopoietic cell transplantation. Blood. 2012 Mar 15. 119(11):2644-56. [Medline].

  53. Jain M, Badwal S, Pandey R, Srivastava A, Sharma RK, Gupta RK. Post-transplant lymphoproliferative disorders after live donor renal transplantation. Clin Transplant. 2005 Oct. 19(5):668-73. [Medline].

  54. Perrine SP, Hermine O, Small T, Suarez F, O'Reilly R, Boulad F. A phase 1/2 trial of arginine butyrate and ganciclovir in patients with Epstein-Barr virus-associated lymphoid malignancies. Blood. 2007 Mar 15. 109(6):2571-8. [Medline].

  55. Hartmann C, Schuchmann M, Zimmermann T. Posttransplant lymphoproliferative disease in liver transplant patients. Curr Infect Dis Rep. 2011 Feb. 13(1):53-9. [Medline].

  56. Jaksch P, Wiedemann D, Kocher A, Muraközy G, Augustin V, Klepetko W. Effect of Cytomegalovirus Immunoglobulin on the Incidence of Lymphoproliferative Disease After Lung Transplantation: Single-Center Experience With 1157 Patients. Transplantation. 2013 Jan 29. [Medline].

  57. Gordan LN, Grow WB, Pusateri A, Douglas V, Mendenhall NP, Lynch JW. Phase II trial of individualized rituximab dosing for patients with CD20-positive lymphoproliferative disorders. J Clin Oncol. 2005 Feb 20. 23(6):1096-102. [Medline].

  58. Choquet S, Oertel S, LeBlond V, Riess H, Varoqueaux N, Dörken B. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol. 2007 Aug. 86(8):599-607. [Medline].

  59. Choquet S, Leblond V, Herbrecht R, Socié G, Stoppa AM, Vandenberghe P. Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of a prospective multicenter phase 2 study. Blood. 2006 Apr 15. 107(8):3053-7. [Medline].

  60. Trappe R, Oertel S, Leblond V, Mollee P, Sender M, Reinke P. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb. 13(2):196-206. [Medline].

  61. Cohen JI. Epstein-Barr virus lymphoproliferative disease associated with acquired immunodeficiency. Medicine (Baltimore). 1991 Mar. 70(2):137-60. [Medline].

  62. Suryanarayan K, Natkunam Y, Berry G, Bangs CD, Cherry A, Dahl G. Modified cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone therapy for posttransplantation lymphoproliferative disease in pediatric patients undergoing solid organ transplantation. J Pediatr Hematol Oncol. 2001 Oct. 23(7):452-5. [Medline].

  63. Taylor AL, Bowles KM, Callaghan CJ, Wimperis JZ, Grant JW, Marcus RE. Anthracycline-based chemotherapy as first-line treatment in adults with malignant posttransplant lymphoproliferative disorder after solid organ transplantation. Transplantation. 2006 Aug 15. 82(3):375-81. [Medline].

  64. Gross TG, Bucuvalas JC, Park JR, Greiner TC, Hinrich SH, Kaufman SS. Low-dose chemotherapy for Epstein-Barr virus-positive post-transplantation lymphoproliferative disease in children after solid organ transplantation. J Clin Oncol. 2005 Sep 20. 23(27):6481-8. [Medline].

  65. Gross TG, Orjuela MA, Perkins SL, Park JR, Lynch JC, Cairo MS, et al. Low-Dose Chemotherapy and Rituximab for Posttransplant Lymphoproliferative Disease (PTLD): A Children's Oncology Group Report. Am J Transplant. 2012 Aug 6. [Medline].

  66. Twist CJ, Kjelson L, Esquivel CO, Castillo RO. Treatment of recurrent post-transplant lymphoproliferative disorder (PTLD) of the Central Nervous System (CNS) with high-dose methotrexate (HD-MTX). Proceedings of the XIIth International Small Bowel Transplant Symposium. 2011.

  67. Nabors LB, Palmer CA, Julian BA, Przekwas AM, Kew CE. Isolated central nervous system posttransplant lymphoproliferative disorder treated with high-dose intravenous methotrexate. Am J Transplant. 2009 May. 9(5):1243-8. [Medline].

  68. Czyzewski K, Styczynski J, Krenska A, Debski R, Zajac-Spychala O, Wachowiak J. Intrathecal therapy with rituximab in central nervous system involvement of post-transplant lymphoproliferative disorder. Leuk Lymphoma. 2013 Mar. 54(3):503-6. [Medline].

  69. Izadi M, Fazel M, Saadat SH, Taheri S. Radiotherapy is the best treatment method in post transplant lymphoproliferative disorders localizing in brain: a review of the literature. Ann Transplant. 2011 Oct-Dec. 16(4):126-33. [Medline].

  70. Haque T, Wilkie GM, Jones MM, Higgins CD, Urquhart G, Wingate P. Allogeneic cytotoxic T-cell therapy for EBV-positive posttransplantation lymphoproliferative disease: results of a phase 2 multicenter clinical trial. Blood. 2007 Aug 15. 110(4):1123-31. [Medline].

  71. Sun Q, Burton R, Reddy V, Lucas KG. Safety of allogeneic Epstein-Barr virus (EBV)-specific cytotoxic T lymphocytes for patients with refractory EBV-related lymphoma. Br J Haematol. 2002 Sep. 118(3):799-808. [Medline].

  72. Green M. Management of Epstein-Barr virus-induced post-transplant lymphoproliferative disease in recipients of solid organ transplantation. Am J Transplant. 2001 Jul. 1(2):103-8. [Medline].

  73. Borenstein J, Pezzella F, Gatter KC. Plasmablastic lymphomas may occur as post-transplant lymphoproliferative disorders. Histopathology. 2007 Dec. 51(6):774-7. [Medline].

  74. Brunner B, Kropshofer G, Ellemunter H, Brunner A, Mueller T, Margreiter R. Severe cold agglutinin disease caused by recurrent monomorphic Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD), clonally related to an EBV-negative plasmacytic hyperplasia in a pediatric multivisceral organ transplant recipient. Pediatr Transplant. 2007 Aug. 11(5):547-51. [Medline].

  75. Buadi FK, Heyman MR, Gocke CD, et al. Treatment and outcomes of post-transplant lymphoproliferative disease: a single institution study. Am J Hematol. 2007 Mar. 82(3):208-14. [Medline].

  76. Chan TS, Hwang YY, Gill H, Au WY, Leung AY, Tse E. Post-transplant lymphoproliferative diseases in Asian solid organ transplant recipients: late onset and favorable response to treatment. Clin Transplant. 2012 Sep-Oct. 26(5):679-83. [Medline].

  77. Comoli P, Maccario R, Locatelli F, et al. Treatment of EBV-related post-renal transplant lymphoproliferative disease with a tailored regimen including EBV-specific T cells. Am J Transplant. 2005 Jun. 5(6):1415-22. [Medline].

  78. Dharnidharka VR, Araya CE. Post-transplant lymphoproliferative disease. Pediatr Nephrol. 2009 Apr. 24(4):731-6. [Medline].

  79. Dharnidharka VR, Talley LI, Martz KL, Stablein DM, Fine RN. Recombinant growth hormone use pretransplant and risk for post-transplant lymphoproliferative disease--a report of the NAPRTCS. Pediatr Transplant. 2008 Sep. 12(6):689-95. [Medline].

  80. Dhillon MS, Rai JK, Gunson BK, Olliff S, Olliff J. Post-transplant lymphoproliferative disease in liver transplantation. Br J Radiol. 2007 May. 80(953):337-46. [Medline].

  81. Doesch AO, Konstandin M, Celik S, Kristen A, Frankenstein L, Sack FU. Epstein-Barr virus load in whole blood is associated with immunosuppression, but not with post-transplant lymphoproliferative disease in stable adult heart transplant patients. Transpl Int. 2008 Oct. 21(10):963-71. [Medline].

  82. Evens MA, David KA, Helenowski I, et al. Multicenter analysis of 80 solid organ transplantation recipients with post-transplantation lymphoproliferative disease. J Clin Oncol. 2010. 28:1038-1046.

  83. Fohrer C, Cailliard S, Koumarianou A. Long term survival in post-transplatn lymphoproliferative disorders with a dose-adjusted ACVBP regimen. Br J Hematol. 2006. 134:601-12. [Medline].

  84. Gautam A, Morrissey PE, Brem AS, et al. Use of an immune function assay to monitor immunosuppression for treatment of post-transplant lymphoproliferative disorder. Pediatr Transplant. 2006 Aug. 10(5):613-6. [Medline].

  85. Ghobrial IM, Habermann TM, Ristow KM, Ansell SM, Macon W, Geyer SM. Prognostic factors in patients with post-transplant lymphoproliferative disorders (PTLD) in the rituximab era. Leuk Lymphoma. 2005 Feb. 46(2):191-6. [Medline].

  86. Giraldi E, Provenzi M, Fiocchi R, Colledan M, Cornelli P, Torre G. Fludarabine, cyclophosphamide, doxorubicin (FCD), and rituximab: a remission induction therapy for aggressive pediatric post-transplant lymphoproliferative disease (PTLD). Pediatr Blood Cancer. 2011 Aug. 57(2):324-8. [Medline].

  87. Gross TG. Post-transplant lymphoproliferative disease in children following solid organ transplant and rituximab--the final answer?. Pediatr Transplant. 2007 Sep. 11(6):575-7. [Medline].

  88. Gupta S, Fricker FJ, González-Peralta RP, Slayton WB, Schuler PM, Dharnidharka VR. Post-transplant lymphoproliferative disorder in children: recent outcomes and response to dual rituximab/low-dose chemotherapy combination. Pediatr Transplant. 2010 Nov. 14(7):896-902. [Medline].

  89. Hatton O, Martinez OM, Esquivel CO. Emerging therapeutic strategies for Epstein-Barr virus+ post-transplant lymphoproliferative disorder. Pediatr Transplant. 2012 May. 16(3):220-9. [Medline].

  90. Hayashida M, Ogita K, Matsuura T, Takahashi Y, Nishimoto Y, Ohga S. Successful prolonged rituximab treatment for post-transplant lymphoproliferative disorder following living donor liver transplantation in a child. Pediatr Transplant. 2007 Sep. 11(6):671-5. [Medline].

  91. Heslop HE. Equal-opportunity treatment of EBV-PTLD. Blood. 2012 Mar 15. 119(11):2436-8. [Medline].

  92. Hourigan MJ, Doecke J, Mollee PN, Gill DS, Norris D, Johnson DW. A new prognosticator for post-transplant lymphoproliferative disorders after renal transplantation. Br J Haematol. 2008 Jun. 141(6):904-7. [Medline].

  93. Icheva V, Kayser S, Wolff D, Tuve S, Kyzirakos C, Bethge W. Adoptive transfer of epstein-barr virus (EBV) nuclear antigen 1-specific t cells as treatment for EBV reactivation and lymphoproliferative disorders after allogeneic stem-cell transplantation. J Clin Oncol. 2013 Jan 1. 31(1):39-48. [Medline].

  94. Kamdar KY, Rooney CM, Heslop HE. Posttransplant lymphoproliferative disease following liver transplantation. Curr Opin Organ Transplant. 2011 Jun. 16(3):274-80. [Medline].

  95. Kasiske BL, Kukla A, Thomas D, Wood Ives J, Snyder JJ, Qiu Y. Lymphoproliferative disorders after adult kidney transplant: epidemiology and comparison of registry report with claims-based diagnoses. Am J Kidney Dis. 2011 Dec. 58(6):971-80. [Medline].

  96. Kessler M, Jay N, Molle R, Guillemin F. Excess risk of cancer in renal transplant patients. Transpl Int. 2006 Nov. 19(11):908-14. [Medline].

  97. Kharfan-Dabaja MA, Bazarbachi A. Emerging role of CD20 blockade in allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2010 Oct. 16(10):1347-54. [Medline].

  98. Khedmat H, Taheri S. Lymphoproliferative disorders in pediatric liver allograft recipients: a review of 212 cases. Hematol Oncol Stem Cell Ther. 2012. 5(2):84-90. [Medline].

  99. Manlhiot C, Pollock-Barziv SM, Holmes C, Weitzman S, Allen U, Clarizia NA. Post-transplant lymphoproliferative disorder in pediatric heart transplant recipients. J Heart Lung Transplant. 2010 Jun. 29(6):648-57. [Medline].

  100. Nakanishi C, Kawagishi N, Sekiguchi S, Akamatsu Y, Sato K, Miyagi S. Post-transplantation lymphoproliferative disorder in living-donor liver transplantation: a single-center experience. Surg Today. 2012 Aug. 42(8):741-51. [Medline].

  101. Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, et al. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol. 2010 Apr 16. [Medline].

  102. Reshef R, Vardhanabhuti S, Luskin MR, Heitjan DF, Hadjiliadis D, Goral S. Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder(?). Am J Transplant. 2011 Feb. 11(2):336-47. [Medline].

  103. Rinaldi A, Kwee I, Poretti G, Mensah A, Pruneri G, Capello D. Comparative genome-wide profiling of post-transplant lymphoproliferative disorders and diffuse large B-cell lymphomas. Br J Haematol. 2006 Jul. 134(1):27-36. [Medline].

  104. Scarsbrook AF, Warakaulle DR, Dattani M, Traill Z. Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 2005 Jan. 60(1):47-55. [Medline].

  105. Trappe R, Oertel S, Leblond V, Mollee P, Sender M, Reinke P. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol. 2012 Feb. 13(2):196-206. [Medline].

  106. Twombley K, Pokala H, Ardura MI, Harker-Murray P, Johnson-Welch SF, Weinberg A. Intraventricular rituximab and systemic chemotherapy for treatment of central nervous system post-transplant lymphoproliferative disorder after kidney transplantation. Pediatr Transplant. 2012 Sep. 16(6):E201-9. [Medline].

  107. Wasson S, Zafar MN, Best J, Reddy HK. Post-transplantation lymphoproliferative disorder in heart and kidney transplant patients: a single-center experience. J Cardiovasc Pharmacol Ther. 2006 Mar. 11(1):77-83. [Medline].

  108. Wudhikarn K, Holman CJ, Linan M, Blaes AH, Dunitz JM, Hertz ME. Post-transplant lymphoproliferative disorders in lung transplant recipients: 20-yr experience at the University of Minnesota. Clin Transplant. 2011 Sep-Oct. 25(5):705-13. [Medline].

  109. Wudhikarn K, Holman CJ, Linan M, Blaes AH, Dunitz JM, Hertz ME. Post-transplant lymphoproliferative disorders in lung transplant recipients: 20-yr experience at the University of Minnesota. Clin Transplant. 2011 Sep-Oct. 25(5):705-13. [Medline].

  110. Yoon SO, Yu E, Cho YM, Suh C, Kim KM, Han DJ. Post-transplant lymphoproliferative disorders: clinicopathological analysis of 43 cases in a single center, 1990-2009. Clin Transplant. 2012 Jan-Feb. 26(1):67-73. [Medline].

  111. Zimmermann T, Hoppe-Lotichius M, Tripkovic V, Barreiros AP, Wehler TC, Zimmermann A, et al. Liver transplanted patients with preoperative autoimmune hepatitis and immunological disorders are at increased risk for Post-Transplant Lymphoproliferative Disease (PTLD). Eur J Intern Med. 2010 Jun. 21(3):208-15. [Medline].

Biopsy of gingival tissue (400 X) with hematoxylin and eosin stain demonstrates polymorphous infiltrate of atypical lymphoid cells, which is consistent with posttransplant lymphoproliferative disease (PTLD).
Biopsy of gingival tissue (400 X). Epstein-Barr virus encoded RNA (EBER) study shows numerous positive cells, which is consistent with posttransplant lymphoproliferative disease (PTLD).
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.