Analysis of Post-Transplant Lymphoproliferative Disorder (PTLD) Outcomes with Epstein-Barr Virus (EBV) Assessments-A Single Tertiary Referral Center Experience and Review of Literature

Simple Summary Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations that develop in up to 10-15% of immunosuppressed recipients of solid organ transplantation (SOT), bone marrow and/or hematopoietic stem cell allograft. Its prevalence is expected to rise as transplant numbers increase. We performed a single-center retrospective study on the characteristics and outcomes of PTLD at our center in the rituximab era. Infants have been suggested to be a unique population of patients who develop PTLD later due to delayed Epstein-Barr virus (EBV) infection and the presence of maternal antibodies. We found that when compared to older cohorts, infant recipients of SOT had a numerically longer time to PTLD diagnosis. Epstein-Barr virus (EBV) positivity has not been shown to impact survival of patients with PTLD, but we suggest that EBV viral load at time of diagnosis could be investigated further as a marker of survival in patients with EBV-positive PTLD. Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations ranging from polyclonal reactive proliferations to overt lymphomas that develop as consequence of immunosuppression in recipients of solid organ transplantation (SOT) or allogeneic bone marrow/hematopoietic stem cell transplantation. Immunosuppression and Epstein-Barr virus (EBV) infection are known risk factors for PTLD. Patients with documented histopathologic diagnosis of primary PTLD at our institution between January 2000 and October 2019 were studied. Sixty-six patients with PTLD following SOT were followed for a median of 9.0 years. The overall median time from transplant to PTLD diagnosis was 5.5 years, with infant transplants showing the longest time to diagnosis at 12.0 years, compared to pediatric and adolescent transplants at 4.0 years and adult transplants at 4.5 years. The median overall survival (OS) was 19.0 years. In the monomorphic diffuse large B-cell (M-DLBCL-PTLD) subtype, median OS was 10.7 years, while median OS for polymorphic subtype was not yet reached. There was no significant difference in OS in patients with M-DLBCL-PTLD stratified by quantitative EBV viral load over and under 100,000 copies/mL at time of diagnosis, although there was a trend towards worse prognosis in those with higher copies.