**5. Conclusion**

*4.4.3. Plasmacytic hyperplasia PTLD*

*4.4.4. T-cell lymphoma PTLD*

*4.4.5. Relapses*

190 Heart Transplantation

autograft.

**4.5. Cell therapy**

This rare form of early lesions can be treated with radiotherapy or lymphoma chemotherapy.

**Figure 5.** Response of a monomorphic diffuse large B cell PTLD after four rituximab and after four R-CHOP.

This type of PTLD has a very poor prognosis, rituximab is useless and the classic chemotherapy-type CHOP has little effectiveness. In case of localized form, radiotherapy may be useful.

Relapses after complete remission are rare; if they occur late after the first PTLD, a comparison of the clones is necessary because a second PTLD, independent of the first one, is possible; if it is the case, the algorithm of first line, describes previously, can be reused, and the maximum dose of anthracycline will not be reached. In other cases, NHL treatments of immunocompetent patients in relapse may be used, even hematopoietic stem cell

Cell therapy is not yet available outside study protocols. Its principle is to use T cells specifically directed against EBV antigens, so it is only applicable to half of PTLDs. It is mostly the allogeneic lymphocyte banks, from healthy donors, that are promising. The lymphocytes are selected according to the HLA typing of the tumor. In the Scottish experience, 12 PTLDs are a clearly defined entity, representing the most increased cancer among cardiactransplant recipients compared to the general population. Its management, from preemptive treatment to curative treatment, has been considerably improved in order to obtain a survival rate similar to that of other transplant recipients. The treatment deviates significantly from that of immunocompetent lymphomas and requires management by teams accustomed to this type of pathology, both for the follow-up of the transplant and for the hematological treatment. The development of cell therapies is very likely the next step in progress.
