Organ transplant-related lymphoma

Post-transplant lymphoproliferative disorder is a curable disease in which a wide range of treatment strategies has met with a degree of success. Both the disease and the organ transplant setting in which it occurs are highly variable. A sequential approach to treatment is preferred, starting with reduction in immunosuppressives. Rituximab or interferon alfa can be tried next, in the hope of avoiding chemotherapy. Rituximab has significant activity and has shown no additional toxicities in transplant recipients. It may be appropriate to add rituximab to the initial treatment in critically ill patients. Cytotoxic chemotherapy is effective but significantly more toxic in this patient population. Effective therapy should be instituted before progressive disease results in declining performance status and multi-organ dysfunction. The goal of treatment is complete and durable remission. Adoptive T-cell therapy is an effective and promising alternative for allogeneic bone marrow transplant recipients.