13. PTC: Cancer Types: Blood & Lymphoma
About PTLD CANCER (aka: Post-Transplant Lymphoproliferative Disease)
Post-transplant lymphoproliferative disease (PTLD) is a type of cancer or lymphoma that may occur after bone marrow or organ transplant. A patient who receives a transplant must take medications to suppress their immune system (immunosuppression) so that their body will not reject the new bone marrow or organ.
When the immune system is suppressed, it is easier to become sick. Sometimes when a transplant patient is infected with Epstein-Barr virus (EBV), the virus may cause a serious cancer or lymphoma known as PTLD.
EBV is a common virus that infects over 90% of people in the world. For most healthy people, it causes common cold like symptoms and then stays in your body but is completely controlled by your immune system, so you don’t have any further symptoms after the initial infection. If a person has a suppressed immune system, the EBV can activate and cause an uncontrolled growth of cells in the patient’s lymph nodes and other organs. When abnormal cells multiply out of control, it may result in cancer.
PTLD is a common cancer after transplant but is still considered a rare disease that only occurs in a small percentage of transplant patients. Rates of PTLD cancer are higher for people who have types of bone marrow and organ transplants that require higher levels of immunosuppression.
The symptoms may vary for PTLD cancer, but some of the common symptoms may include:
- Painless swelling of lymph nodes in your neck, armpits or groin
- Upper respiratory tract symptoms:
- Scratchy or sore throat
- Shortness of breath
- Unintentional weight loss
- Decrease of appetite
- Night sweats
If you are experiencing any of these symptoms please consult with your treating physician.
And from the article at https://www.verywell.com/non-hodgkin-lymphoma-nhl-after-organ-transplantation-2252376 . . .
The risk of developing lymphoma is markedly increased after solid organ transplantation for example kidney transplants, liver transplants, heart transplants or lung transplants. These lymphomas are medically termed "post-transplant lymphoproliferative disorders" or PTLDs.
Non-Hodgkin lymphoma is a type of cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.
The lymphatic system is part of your immune system.
Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes.
In non-Hodgkin lymphoma, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands).
The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.
The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.
Non-Hodgkin lymphoma can occur at any age, but your chances of developing the condition increase as you get older, with just over a third of cases diagnosed in people over 75.
Slightly more men than women are affected.
How Common is Lymphoma after Organ Transplant?
PTLD includes a wide variety of lymphoproliferative conditions following solid organ or hematopoietic stem cell transplantation (HSCT) and may occur 10 percent of adults post transplant. A range of 1 to 20 percent has also been used to estimate the overall incidence of post-transplant LPD .
Why Do Lymphomas Occur after Organ Transplant?
Post-transplant lymphomas are almost always related to infection by the Epstein Barr Virus (EBV). Infection by the Epstein Barr Virus causes a transformation of B-cells (a type of lymphocyte or white blood cell) which becomes cancerous. In normal individuals other cells of the immune system can tackle the EBV infection, but for people with organ transplants, high doses of drugs that suppress the immune system must be administered. With nothing to control the infection, the chances of developing lymphomas increase.
What Factors Increase the Risk of Post-Transplant Lymphoma?The two main factors that determine the chances of getting lymphoma are:
- How much immunosuppressive treatment is required – The more the immunosuppression, the more the chances of EBV infection.
- The status of EBV serology of the recipient of the transplant – If the individual has previously been infected by EBV (has a history of having had mono) the chances are that the body remembers the infection and the blood already has special proteins called antibodies that can identify and kill the virus. That can be tested by taking a blood sample.
How Do Post-Transplant Lymphomas Behave?On average, if PTLD is going to occur, a typical time for it to do so is at about 6 months post transplant in solid organ transplant patients and 2–3 months in HSCT recipients, but it has been reported as soon as 1 week and as late as 10 years after transplant.
Post-transplant lymphomas are usually different from the usual Non-Hodgkin lymphomas. The cancer cells of this lymphoma are of a mixture of different shapes and sizes. While most patients have involvement mainly of lymph nodes, other organs are very commonly affected as well – a phenomenon called ‘extranodal’ involvement. These include the brain, lungs and the intestines. The transplanted organ can also get involved.
How is Post-Transplant Lymphoma Treated?Whenever possible, immunosuppressive treatment has to be reduced or stopped. In those who have small and localized disease, surgery or radiation may be attempted. If not, the first line of treatment is usually Rituxan (rituximab), a monoclonal antibody that specifically targets lymphoma cells. Only when this fails is chemotherapy attempted. Chemotherapy is deferred until necessary as in partially immunosuppressed individuals chemotherapy may further increase the risk of infections.
In those who develop lymphomas after bone marrow transplants, donor leukocyte transfusions can be highly effective.
What are the Outcomes with Post-Transplant Lymphomas?In general, PTLD is a major cause of illness and death, historically with published mortality rates up to 40–70 percent in patients with solid organ transplants and 90 precent in patients post HSCT. Non-Hodgkin lymphomas occurring after organ transplants have a poorer outcome than other NHLs. Another published figure has been that around 60-80% ultimately succumb to their lymphoma. However, the use of Rituxan has changed the survival rate, and some individuals do fare a lot better and may get cured.
Involvement of other organs, especially the brain, has a poor prognosis.
He, G., Wang, C., Tan, H., and S. He. Rituximab after autologous stem cell transplantation enhances survival of B-cell lymphoma patients: a meta-analysis and systematic review. Transplant Proceedings. 2015. 47(2):517-22.