Questions about PTLD and NHL

1: On the website I read the risk of getting a lymphoma at 1/417 for the general population, calculated it to 1/139 for the transplant population and calculated it to 1/55 for my situation with my serology status change post transplant. Is my understanding of the risk correct?

2: Valganciclovir was given to me for 3 months after transplant. Was that due to the increase risk of PTLD from the kidney that was EBV+ being donated to a patient who was EBV- The literature talks about it as a prophylactic.

3: Is anyone at the Ottawa General involved in any EBV/PTLD type working groups, anyone you know of anywhere?

What follows is not a question but rather background information on PTLD and EBV from Solid Organ Transplant and Immune suppression.


Nijland ML, Kersten MJ, Pals ST, Bemelman FJ, Ten Berge IJ. Epstein-Barr Virus-Positive Posttransplant Lymphoproliferative Disease After Solid Organ Transplantation: Pathogenesis, Clinical Manifestations, Diagnosis, and Management. Transplant Direct. 2015 Dec 15;2(1):e48. doi: 10.1097/TXD.0000000000000557. PMID: 27500242; PMCID: PMC4946499.

~Posttransplant lymphoproliferative disease (PTLD) is a potentially fatal complication after (solid organ) transplantation, which is highly associated with Epstein-Barr virus (EBV).

~The EBV-specific cytotoxic T cell response that is essential in controlling the virus in healthy individuals is suppressed in transplant recipients using immunosuppressive drugs.

~A primary EBV infection in EBV-seronegative patients receiving an EBV-seropositive donor organ or a reactivation in those who are already latently infected pretransplantation can lead to uninhibited growth of EBV-infected B cells and subsequently to PTLD.

~Effective preventive strategies, such as vaccines and antiviral agents, are lacking.

~Not every transplant recipient with increasing EBV viral load develops PTLD, so it is hard to decide how intensively these patients should be monitored and how and when a preemptive intervention should take place.

~There is a need for other tools to help predict the development of PTLD in patients at risk to make timing and strategy of preemptive intervention easier and more reliable.

~The cornerstone of the treatment of patients with PTLD is restoring the host’s immunity by reduction of immunosuppressive drug therapy.

~American and British guidelines recommend to add rituximab monotherapy or rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisolone, depending on histology and clinical characteristics.

~Although response to these therapies is good, toxicity is a problem, and PTLD still has a relatively high mortality rate.

~An evolving therapy, especially in PTLD occurring in allogeneic stem cell transplantation, is restoring the host’s immune response with infusion of EBV-specific cytotoxic T cells. This may also play a role in the future in both prevention and treatment of PTLD in SOT.

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