Post Transplant Lymphoproliferative Disorder-PTLD
Description
Post Transplant Lymphoproliferative Disorder (PTLD) is a lymphoid proliferation arising in a recipient of a solid organ transplant, allogeneic bone marrow transplantation, or an umbilical cord blood transfusion. The patient must have a history of a solid organ transplant or an allogeneic bone marrow transplant. Both polymorphic and monomorphic PTLD are actually caused by post-transplant immunosuppression. Most cases of PTLD occur within a year of transplantation; however, they can occur any time after the transplant. Monomorphic PTLD may have histology indistinguishable from that of various malignant hematopoietic neoplasms, particularly lymphomas such as Diffuse Large B-cell Lymphoma.
Rationale
The presence of PTLD, either polymorphic or monomorphic, has clinical significance and prognostic value, especially in the Pediatric and Adolescence and Young Adult (AYA) populations.
Notes
**Note 1:** **Effective years**
* This SSDI is effective for diagnosis years 2025+
* For cases diagnosed 2018-2024, this SSDI must be blank
**Note 2:** **Definition of PTLD**
* Post Transplant Lymphoproliferative Disorder (PTLD) is a lymphoid proliferation arising in a recipient of a solid organ transplant, allogeneic bone marrow transplantation, or an umbilical cord blood transfusion.
* The development of PTLD is clinically significant and a prognostic indicator
* See the Hematopoietic database for more information
**Note 3:** **Types of PTLD**
* **Polymorphic PTLD**: This is a PTLD by itself, there is no accompanying lymphoma, plasmacytoma or other type of Hematopoietic neoplasm. This type of PTLD is NOT collected in this data item.
* **Monomorphic PTLD (Code 1)**: This is the most common PTLD and is associated with a malignant hematopoietic neoplasm. Most common, but not limited to, diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma
* **(Classic Hodgkin lymphoma-PTLD type (Code 2)**: Under the microscope, Reed-Sternberg cells, which are associated with Hodgkin lymphoma are present
* **PTLD, NOS (Code 4)**: Used when only PTLD (NOS) is documented and there is no mention of monomorphic or Hodgkin like type
Coding Guidelines
**See the Hematopoietic manual (Rules M14 and PH1. Hematopoietic Project - SEER Registrars (cancer.gov))**
**1.** Code 0 when there is no mention of PTLD on the pathology report or medical record
**2.** Code 1 when the pathology report describes monomorphic PTLD with a lymphoma
**3.** Code 2 when the pathology report describes Classic Hodgkin lymphoma-PTLD type
**4.** Code 4 when the pathology report describes a Burkitt like PTLD or doesn’t specify what type of PTLD
***Examples (Courtesy of Ask a SEER Registrar)***
**1.** Staining supports the diagnosis of PTLD, monomorphic type, EBV+ diffuse large b-cell lymphoma (non-germinal center) *(Code histology 9680/3, PTLD data item-1)*
**2.** Monomorphic post-transplant lymphoproliferative disorder (Plasma cell myeloma), EBV negative. Monoclonal kappa plasmacytosis (estimated 20% by CD138 IHC). *(Code histology, 9732/3, PTLD data item: 1)*
**3.** Per Physician, Stage IIA (bulk) PTLD - Hodgkin-like morphology, Intermediate risk. *(Code histology 9650/3, PTLD data item: 2)*
**4.** High grade b cell lymphoma/Burkitt like post-transplant lymphoproliferative disorder. *(Code histology 9687/3, PTLD data item-4)*
**5.** Non-Hodgkin malignant lymphoma with plasmablastic features. Represents a post-transplant/immunodeficiency-related malignant lymphoma. *(Code histology 9590/3, PTLD data item: 4)*
**6.** Colonoscopy w/bx showed diffuse large B-cell lymphoma w/PTLD. *(Code histology 9680/3, PTLD data item 4)*
**7.** Right inguinal lymph node biopsy that shows a CD20+ polymorphic PTLD *(Not collected in this schema. Effective 2025+, this would be abstracted as 9971/3 and collected in the HemeRetic schema)*
Default
8
Metadata
SSDI 2025–
| Code |
Description |
| 0 |
PTLD not documented on the pathology report or in the medical record |
| 1 |
Monomorphic PTLD
* PTLD WITH a specified histology (lymphoma, plasmacytoma, plasma cell myeloma) |
| 2 |
Classic Hodgkin lymphoma-PTLD type
PTLD, Hodgkin like |
| 4 |
PTLD not specified as monomorphic or Hodgkin lymphoma-PTLD type
• WITH a specified histology (lymphoma, plasmacytoma, plasma cell myeloma)
• Includes Burkitt type PTLD |
| 8 |
Not applicable: Information not collected for this case
(If this item is required by your standard setter, use of code 8 will result in an edit error) |
| <BLANK> |
Diagnosis year prior to 2025 |
