Monitoring and clinical presentation

Vigilance for signs of EBV+PTLD is important

Although there are no widely adopted guidelines, routine monitoring of EBV reactivation post-transplant is widely available.1,2

Protocols and the distribution of EBV polymerase-chain-reaction (PCR) values for viral load vary between patient cases and centers, but a high or rapidly increasing viral load is associated with an increased risk of PTLD.1,2

Transplant recipients with PTLD have a significantly higher viral load than recipients without PTLD, and a higher or rapidly increasing viral load is associated with an increased risk of PTLD.1

Two vials of blood cells

An early determination of risk, close observation of EBV DNA levels, and prompt initiation of therapy are essential to improving patients’ overall prognosis.3

Clinical presentation of EBV+PTLD:

Classic B symptoms such as pyrexia, sweats, and weight loss can occur. Clinical features of PTLD are often nonspecific, while extranodal involvement is common, including the gastrointestinal tract, lungs, skin, bone marrow, and central nervous system.4

References

1. Dierickx D, Habermann TM. Post-transplantation lymphoproliferative disorders in adults. N Engl J Med. 2018;378:549-562. 2. Fox CP, Burns D, Parker AN, et al. EBV-associated post-transplant lymphoproliferative disorder following in vivo T-cell-depleted allogeneic transplantation: clinical features, viral load correlates and prognostic factors in the rituximab era. Bone Marrow Transplant. 2014;49:280-286. 3. Jiménez S. Epstein-Barr virus-associated post-transplantation lymphoproliferative disorder: potential treatments and implications for nursing practice. Clin J Oncol Nurs. 2015;19:94-98. 4. Al-Mansour Z, Nelson BP, Evens AM. Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies. Curr Hematol Malig Rep. 2013;8:173-183. 5. Uhlin M, Wikell H, Sundin M, et al. Risk factors for Epstein-Barr virus-related post-transplant lymphoproliferative disease after allogeneic hematopoietic stem cell transplantation. Haematologica. 2014;99:346-352. 6. Choquet S, Oertel S, LeBlond V, et al. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol. 2007;86:599-607.