Posttransplant Lymphoproliferative Disease after Lung Transplantation

Figure 2

This algorithm proposes routine surveillance of high-risk patients to enable diagnosis at an early stage. Starting with EBV viral load monitoring, patients who manifest elevated levels with symptoms would progress to imaging studies and biopsy of enlarged lymph nodes or nodules. Identification of CD20 lesion positivity, cytogenetics, immunostaining for LMP and EBER, and assessment of monoclonal or polyclonal proliferation can focus further therapy. In localized disease, reduction of immunosuppression or surgery may be sufficient to control disease, while rituximab may be given concurrently. High-grade extensive disease may require chemotherapy, bortezomib, or EBV-specific cytotoxic T lymphocytes if available. From [60].