Primary central nervous system lymphoma in the transplant patient

Approximately 2 per cent of organ transplant recipients develop primary CNS lymphomas. There is no pathognomonic clinical or radiographic presentation of the tumor, although multicentric involvement of deep white matter is common. Evidence has linked PCNSL to immunosuppression and to infection with the EBV. The most reasonable sequence of events leading to the development of this tumor appears first to be an infection with (or reactivation of) EBV following immunosuppression. The virus then produces B cell lymphoproliferation that is unchecked because of suppression of the normal immune mechanisms. At some point, the lymphoproliferation becomes neoplastic, and a lymphoma results. Reduction in immunosuppression and antiviral treatment may be of use in the treatment of PCNSL in transplant patients.