Treatment advances in posttransplant lymphoproliferative disease

Epstein-Barr virus-associated posttransplant lymphoproliferative disease (PTLD) is a life-threatening complication of organ transplantation. As we continue to observe improved outcomes of patients living after solid or hematopoietic stem cell transplantation, we can expect to see a parallel increase in the incidence of PTLD. Several innovative therapeutic approaches are currently under development to add to our arsenal of treatment strategies in this devastating disease.

The past decade has witnessed significant progress in the understanding and treatment of PTLD. The tolerability and effectiveness of standard treatment regimens, such as a reduction in immunosuppression, rituximab, and chemotherapy, have been confirmed and improved upon. Newer options for treatment demonstrating significant promise include antiviral therapy with arginine butyrate, as well as Epstein-Barr virus-specific cytotoxic T-cell therapy.

Both the heterogeneous PTLD population and the lack of standardized and evidence-based treatment approaches make treatment a difficult decision for the clinician. This article reviews and updates the evidence behind accepted strategies such as reduction in immunosuppression, rituximab, and chemotherapy, as well as explores novel and effective therapeutic modalities including antiviral therapy with arginine butyrate and adoptive allogeneic T-cell therapy.