Understanding Post-Transplant Lymphoproliferative Disorder (PTLD)

Post-Transplant Lymphoproliferative Disorder (PTLD) is a rare form of cancer that can develop after an organ or bone marrow transplant. This fact sheet will cover:

• How PTLD forms
• Potential symptoms of PTLD
• Testing for PTLD
• Treatment for PTLD

What Is PTLD?

After an organ or bone marrow transplant, a patient’s immune system is usually weakened through use of medications that allow the body to accept the new transplant instead of fighting it. These medications are sometimes called ‘immunosuppressants.’

A weakened immune system is not always good at fighting general infections, including the Epstein-Barr virus, sometimes abbreviated as EBV.

Normally very common in most populations, the Epstein-Barr virus can create pre-cancerous cells that can become cancerous over time. If the immune system cannot fight back, this can result in PTLD.

PTLD is a form of lymphoma, a cancer of the lymphatic system where white blood cells change into cancer cells that can grow out of control and spread throughout the body.

Symptoms of PTLD

If it occurs, PTLD is most common in the first year after transplant, although it can form later. Signs of PTLD can depend on the location in the body it formed and how far it has spread. General symptoms include:

• Fatigue
• Fever
• Lack of appetite or unexpected weight loss
• Sweating at night
• Coughing or trouble breathing
• Pain, vomiting, diarrhea, or constipation

The lymph nodes in the armpits, neck or groin may also swell, which may be painless.

Diagnosing PTLD

If you experience symptoms of PTLD, report them right away to your doctor. Tests and scans can determine its presence. These include:

• Blood tests for possible Epstein-Barr virus infection
• Computed tomography (CT) scan of the neck, chest or abdomen
• Positron emission tomography (PET) scan of liver, bones, marrow or spleen
• Biopsies of enlarged lymph nodes or other masses

Along with other tests, these can show whether PTLD is present and how far it might have spread.

Treating PTLD

The first form of treatment after a PTLD diagnosis is often to reduce or stop the medication that is affecting the immune system. This can sometimes be successful in treating the cancer, as the immune system returns to fighting the Epstein-Barr virus.

Other forms of treatment include chemotherapy, immunotherapy and T-cell therapy, depending on what your oncology team determines is best for you.