Prognostic factors in patients with post-transplant lymphoproliferative disorders (PTLD) in the rituximab era

Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Leukemia and Lymphoma (Impact Factor: 2.89). 03/2005; 46(2):191-6. DOI: 10.1080/10428190400012011
Source: PubMed


To assess the effect of rituximab therapy and other prognostic factors on overall survival in patients with post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation, 30 consecutive patients diagnosed with PTLD between 1999 and 2002 were analyzed. Fifteen (50%) patients received rituximab (375 mg/m(2) once a week). Fifteen (50%) patients had other interventions including observation, immunosuppression reduction, surgery, chemotherapy, radiation or a combination of these. Patients receiving rituximab vs. non-rituximab differed in the following variables: age at diagnosis of PTLD (P = 0.009), days to PTLD (P = 0.0005), Epstein-Barr virus (EBV) in situ hybridization status (P = 0.02) and CD20-positive status (P = 0.006). At the time of last follow-up, 10 (33%) patients in the rituximab group and 5 (17%) in the non-rituximab group were alive. On univariate analysis for overall survival of all 30 patients, the significant factors were: treatment with rituximab (P = 0.03), response to treatment (P = 0.005), CD20 positive (P = 0.0004), low international prognostic index (IPI; P = 0.02) and good performance status (P = 0.009). Multivariate analysis of all patients was significant for CD20-positive status (P = 0.0007) and low performance status (P = 0.006). On multivariate analysis for overall survival in patients with CD20-positive PTLD, low IPI (P = 0.004) and rituximab therapy (P = 0.03) were significant. Low IPI and rituximab therapy led to an improved overall survival in patients with CD20-positive PTLD.

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    • "Although this fact does not diminish the importance of chemotherapy in patients with more aggressive PTLD courses, use of rituximab therapy alone or in combination with low dose chemotherapy might provide higher survival rates, both due to lowering adverse effects of chemotherapy and therapeutic effects of rituximab. This idea would be more strengthen when we consider that compared to cytotoxic chemotherapy alone, a combination of chemotherapy and rituximab in the treatment of non-Hodgkin’s lymphoma is more effective (51). more specifically, a trial of six patients with PTLD has showed that a combination of chemotherapy with rituximab was associated with 100% remission rate in their series (52); and based on this finding authors have suggested that rituximab can also sensitize tumoral cells to the effects of chemotherapy. "
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    ABSTRACT: Rituximab, an anti-CD20 agent, has been suggested as an effective strategy to deal with post transplant lymphoproliferative disorders (PTLD). In the current study, we aim to evaluate the efficacy of rituximab therapy in heart transplant population developing PTLD. A comprehensive search of the literature was performed to gather the available data on lymphoproliferative disorders occurring in heart transplant patients. Finally, data of 125 patients from 26 previously published studies were included into the study. Patients who underwent rituximab therapy had significantly worse tumoral histopathology features (P-value= 0.003). Survival analyses showed no significant difference regarding receiving rituximab therapy for heart recipients; however, when the analysis was repeated only including data of pediatric patients, significant beneficial effects for pediatric were found for rituximab therapy. In fact, no children undergoing rituximab therapy died during the follow up. In conclusion, this study showed that rituximab therapy in pediatric heart transplant recipients with PTLD represents surprisingly excellent results, making rituximab an indispensable agent in the management of the disease. To define feasibility of rituximab therapy in adult recipients of heart graft with PTLD, randomized controlled trials are needed.
    07/2013; 3(3):125-134.
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    • "The use of anti-B cell monoclonal antibodies is increasing. In a recent retrospective study of 30 solid organ transplant patients with PTLD at the Mayo Clinic, 15 CD20 and EBER-positive patients who did not respond to reduction of immunosuppression were treated with rituximab [11]. Rituximab was associated with a significantly improved survival by multivariate analysis. "
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    ABSTRACT: Hodgkin's disease is recognized as part of the spectrum of post-transplantation lymphoproliferative disorders (PTLD), although it is still an uncommon de novo malignancy in this population. Epstein-Barr virus (EBV) has been linked to both post-transplant non-Hodgkin's lymphomas and Hodgkin's disease. We report a case of recurrent Hodgkin's disease in a patient who received a renal transplant in childhood and later developed EBV-associated Hodgkin's disease with remission after chemotherapy until subsequent relapse 9 years later that was successfully treated. To our knowledge, this is the first report of recurrent Hodgkin's disease in a transplant recipient. We briefly discuss the pathogenesis of and risk factors for EBV-related PTLD, utility of EBV load surveillance, and the options for treatment of PTLD including immunosuppression reduction, antiviral therapy, anti-CD20 monoclonal antibodies, cytotoxic T cells, and the possible roles of interferon-alpha and rapamycin.
    Transplant International 05/2006; 19(4):338-41. DOI:10.1111/j.1432-2277.2006.00273.x · 2.60 Impact Factor
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