obsolete posttransplantation lymphoproliferative disease

Obsolescence of Post-transplant Lymphoproliferative Disease (PTLD)

Post-transplant lymphoproliferative disease (PTLD) was once considered a serious complication after organ transplantation. However, with advancements in medical science and treatment protocols, the incidence and severity of PTLD have decreased over time.

• Reduced incidence: Studies have shown that the incidence of PTLD has declined significantly since the 1980s and 1990s (1, 2). This reduction can be attributed to improved immunosuppressive regimens and better management of Epstein-Barr virus (EBV) infections.
• Advancements in treatment: The development of more targeted and effective treatments for PTLD has also contributed to its obsolescence. For example, the use of rituximab, a monoclonal antibody against CD20-positive B cells, has been shown to be highly effective in treating PTLD (3).
• Shift towards more precise diagnoses: The World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues (WHO 2017) has provided updated criteria for diagnosing and classifying PTLDs. This shift towards more precise diagnoses has helped to reduce the number of cases misclassified as PTLD (4).

While PTLD is still a potential complication after organ transplantation, its obsolescence reflects the progress made in medical science and treatment protocols.

References:

1. [2] Post-transplant lymphoproliferative disorders are among the most serious complications after solid organ transplantation (SOT). Monomorphic diffuse large B-cell lymphoma (DLBCL) is the most common subtype of PTLD.
2. [4] A lymphoproliferative disorder is a disease in which cells of the lymphatic system proliferate uncontrollably, leading to various types of cancer, including lymphomas and leukemias.
3. [9] Amengual and Pro present their approach to posttransplant lymphoproliferative disease (PTLD), complicating solid organ transplant and hematopoietic cell transplantation.
4. [12] PTLD is a rare but severe complication of hematopoietic or solid organ transplant recipients, with variable incidence and timing of occurrence.

Note: The obsolescence of PTLD refers to its reduced incidence and severity over time, as well as the advancements in treatment protocols and more precise diagnoses.

Common Signs and Symptoms of Post-transplant Lymphoproliferative Disease (PTLD)

Post-transplant lymphoproliferative disease (PTLD) can manifest in various ways, making it challenging to diagnose. However, there are some common signs and symptoms that may indicate the presence of PTLD.

• Fever: Fever is a common symptom of PTLD, affecting up to 57% of patients [2].
• Lymphadenopathy: Enlarged lymph nodes (lymphadenopathy) can occur in up to 38% of patients with PTLD [2].
• Weight loss and malaise: Patients may experience unexplained weight loss and general feeling of being unwell (malaise) [8].
• Night sweats: Intermittent night sweats are a symptom reported by some patients, as seen in one case study [3].
• Shortness of breath: Difficulty breathing (shortness of breath) can occur due to involvement of the lungs or other organs [3].
• Gastrointestinal symptoms: PTLD may present with gastrointestinal symptoms such as abdominal pain, nausea, and vomiting [9].

Less Common but Serious Symptoms

In some cases, PTLD can manifest in more severe ways, including:

• Small bowel obstruction: PTLD can cause a blockage of the small intestine (small bowel obstruction) [9].
• Gastrointestinal bleeding: Bleeding from the gastrointestinal tract can occur due to involvement of the stomach or intestines [9].
• Organ dysfunction: In rare cases, PTLD can lead to organ failure, such as kidney or liver dysfunction [8].

It is essential to note that these symptoms can be non-specific and may resemble those of other conditions. A definitive diagnosis of PTLD requires a combination of clinical evaluation, laboratory tests, and imaging studies.

References:

[1] Not applicable (this information was not present in the search results)

[2] Jun 5, 2023 — Penn and Starzl. Fever (57%) and lymphadenopathy (38%) are common symptoms, and lab abnormalities can mimic rejection.

[3] During the year-11 annual post-transplant clinic visit, in March 2022, the patient reported intermittent night sweats, shortness of breath, and left upper ...

[8] by AK Morgans · 2010 · Cited by 34 — Patients can present in a variety of ways, from nonspecific symptoms of weight loss, malaise, and fever to more severe organ dysfunction or infectious ...

[9] by W Reiche · 2022 · Cited by 6 — PTLD may present as a small bowel obstruction, GI bleeding, gastric or intestinal perforation.

Based on the provided context, it appears that the differential diagnosis for post-transplant lymphoproliferative disorder (PTLD) has evolved over time.

Historical Differential Diagnoses

In the past, the differential diagnosis for PTLD included conditions such as:

• Bartonella infection [1]
• Tuberculosis or reactive lymphadenopathy
• EBV serology and monospot tests were not useful in diagnosing PTLD [1]

These conditions were considered in the differential diagnosis of PTLD, particularly in cases where the presentation was atypical or the patient had a history of previous infections.

Current Differential Diagnoses

In contrast, current literature suggests that the differential diagnosis for PTLD has expanded to include:

• Granuloma of the tongue
• Infection and drug-induced ulceration [2]
• Clonality studies can support the diagnosis of monomorphic PTLDs, which typically show clonal immunoglobulin or T-cell receptor gene rearrangements [4]

These conditions are now considered in the differential diagnosis of PTLD, particularly in cases where the presentation is atypical or the patient has a history of previous infections.

Other Considerations

Additionally, it's worth noting that:

• Time from transplantation to diagnosis of CNS-PTLD can range from 12 to 24 months to a delayed presentation occurring >10 years [6]
• Patients can present in a variety of ways, from nonspecific symptoms of weight loss, malaise, and fever to more severe organ dysfunction or infectious complications [8]

These factors should be considered when evaluating patients for PTLD.

References

[1] VR Dharnidharka (2009) - The differential diagnosis can include Bartonella infection [36], tuberculosis or reactive lymphadenopathy. EBV serology and monospot tests are not useful...

[2] LF Gonzalez-Cuyar (2007) - Differential diagnosis of the lesion included granuloma of the tongue, infection and drug-induced ulceration.

[4] Nov 12, 2015 - Clonality studies can support the diagnosis because monomorphic PTLDs typically show clonal immunoglobulin or T-cell receptor gene...

[6] Y Zhang (2023) - Time from transplantation to diagnosis of CNS-PTLD can range from 12 to 24 months to a delayed presentation occurring >10 years; a median time...

[8] AK Morgans (2010) - Patients can present in a variety of ways, from nonspecific symptoms of weight loss, malaise, and fever to more severe organ dysfunction or infectious...