Prognostic factors in patients with post-transplant lymphoproliferative disorders (PTLD) in the rituximab era.
ABSTRACT 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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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.
Article: Response to Rituximab-Based Therapy and Risk Factor Analysis in Epstein Barr Virus-Related Lymphoproliferative Disorder After Hematopoietic Stem Cell Transplant in Children and Adults: A Study From the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation[Show abstract] [Hide abstract]
ABSTRACT: Background. The objective of this analysis was to investigate prognostic factors that influence the outcome of EBV-related post-transplant lymphoproliferative disorders (PTLD) after a rituximab-based treatment in the allo-HSCT setting. Methods. 4466 allo-HSCTs performed between 1999-2011 in 19 EBMT centres have been retrospectively analysed for PTLD, either biopsy-proven or probable disease. Results. 144 PTLD cases were identified, indicating an overall EBV-PTLD frequency of 3.22%, ranging from 1.16% for matched-family donor, 2.86% for mismatched family donor, 3.97% in matched unrelated donor, and 11.24% in mismatched unrelated donor recipients. EBV-PTLD occurred at a median of 2 months (range, 0.5-53) after HSCT and was proven by biospy in 59.7% cases with the remaining 40.3% being considered probable cases. 69.4% patients survived PTLD. Multivariable analysis showed that a poor response of PTLD to rituximab was associated with an age ≥30 years, involvement of extra-lymphoid tissue, acute GVHD, and a lack of reduction of immunosuppression upon PTLD diagnosis. In the prognostic model, the PTLD mortality increased with the increasing number of factors: 0-1, 2 or 3 factors being associated with mortality of 7%, 37% and 72%, respectively (p<0.0001). Immunosuppression tapering was associated with a lower PTLD mortality (16% vs 39%) and a decrease of EBV-DNA-emia in peripheral blood during therapy was predictive of better survival. Conclusions. Over two-thirds of patients with EBV-PTLD survived after rituximab-based treatment. Reduction of immunosuppression was associated with improved outcome while older age, extra-nodal disease, and acute GVHD predicted poor outcome.Clinical Infectious Diseases 06/2013; 57(6). DOI:10.1093/cid/cit391 · 9.42 Impact Factor
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ABSTRACT: Post-transplant lymphoproliferative disorder (PTLD) is a major complication caused by immune-suppression after transplantation. Survival outcome is known to be poor and the characteristics are not fully understood because of its rare incidence. This single center retrospective study enrolled 41 adult PTLD patients after kidney-transplantation (KT, n=28) and hematopoietic stem cell transplantation (HSCT, n=13) from 1992 to 2012. We compared the characteristics and estimated the survival outcomes according to several factors (age-adjusted-IPI (aaIPI), pathologic subtype, viral status, extranodal manifestation) and added some significant parameters to aaIPI scoring system. Post-HSCT-PTLD patients were younger and showed earlier onset, and viral status was more frequently identified. Ten-year OS of the entire group was 44% but the 10-year OS was not significantly different between post-KT-PTLD and post-HSCT-PTLD (39% vs. 56%, p=0.860). The time onset of PTLD and viral statuses were not meaningful, however, aaIPI, age>50, extranodal manifestation and monomorphic subtype were predictive for OS. We used those factors for PTLD-specific scoring which showed intermediate-risk (HR=7.1, p=0.019) and high-risk (HR=16.5, p=0.001) presented worse OS compared to low-risk subgroup. Although the treatment strategies were heterogenous, this study showed comprehensive PTLD data between KT versus HSCT, and our PTLD-specific scoring might be validated by another larger studies. This article is protected by copyright. All rights reserved.Transplant International 03/2014; 27(7). DOI:10.1111/tri.12328 · 3.16 Impact Factor