Posttransplant lymphoproliferative disorder (PTLD) occurs in solid organ transplant patients. Recent efforts have led to a classification system with a primary morphologic basis, polymorphic versus monomorphic group (lymphoma and Hodgkin's disease). To test the hypothesis that patients with polymorphic morphology are more likely to respond to a reduction in immunosuppression, we recently reviewed the records of 30 pediatric solid organ transplant patients with PTLD (12 lung, 8 liver, 5 heart, 5 kidney).

The histologic subgroups were reviewed and classified as polymorphic (14 patients) or monomorphic or Hodgkin's disease (16 patients). All patients were initially treated with reduction in immunosuppression. In the polymorphic group, reduction in immunosuppression resulted in a complete or partial remission in 12 of 14 (86%) patients versus 4 of 16 (25%) patients with monomorphic PTLD (p<0.05). The median time from transplant to diagnosis of PTLD was 88 days for polymorphic disease and 647 days for monomorphic disease, which were significantly different (p<0.05). Patients with progressive monomorphic disease were subsequently treated with chemotherapy resulting in a partial or complete remission in 9/9 (100%) patients.

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