Irene García-Cadenas1, Lucrecia Yáñez2, Isidro Jarque3, Rodrigo Martino1, Jose Antonio Pérez-Simón4, David Valcárcel5, Jaime Sanz3, Arantxa Bermúdez2, Cristina Muñoz6, Cristina Calderón-Cabrera4, Estefania García7, Laura Alonso5, Maria Suárez-Lledó8, Marta González Vicent9, Inmaculada Heras10, Mª Cruz Viguria11, Montserrat Batlle12, Lourdes Vázquez13, Javier López14, Carlos Solano15. 1. Department of Hematology of the: Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Autonomous University of Barcelona, Barcelona, Spain. 2. HU. Marqués de Valdecilla, Santander, Spain. 3. Hospital La Fe, Valencia, Spain. 4. HU. Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain. 5. Hospital Vall d'Hebrón, Barcelona, Spain. 6. Hospital Gregorio Marañón, Madrid, Spain. 7. Hospital Reina Sofía, Cordoba, Spain. 8. Hospital Clínic Barcelona, Barcelona, Spain. 9. Hospital Niño Jesús, Barcelona, Spain. 10. Hospital Morales Meseguer, Murcia, Spain. 11. Complejo Hospitalario de Navarra, Pamplona, Spain. 12. H. Germans Trias i Pujol, Barcelona, Spain. 13. H. Clínico Universitario de Salamanca, Salamanca, Spain. 14. H. Ramón y Cajal, Madrid, Spain. 15. Hospital Clínico de Valencia, Valencia, Spain.
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is an infrequent complication of allogeneic stem cell transplant (allo-SCT). AIMS: To estimate the frequency and management of PTLD in Spain and to identify prognostic factors influencing outcomes. METHODS: Multicenter, retrospective analysis of allo-SCT performed in 14 transplant units over a 15-year period. RESULTS: 102 PTLD were diagnosed among 12 641 allo-SCT, leading to an estimated frequency of 0.8%. PTLD was diagnosed at a median of 106 days after SCT. Eighty-seven cases (85%) were diagnosed between 2007 and 2013. At diagnosis, 22% and 17% of the patients had gastrointestinal tract and CNS involvement. Eighty-seven (85%) received rituximab treatment, alone or in combination with immunosuppression reduction, with an ORR of 50.6%. With a median follow-up for survivors of 58 months, the 2-year overall survival (OS) was 33% and the PTLD-related mortality 45%. Age ≥ 40 years, malignant underlying disease, non-response to rituximab, and severe thrombocytopenia or lymphocytopenia at PTLD diagnosis were associated with worse overall survival. CONCLUSIONS: Only a small proportion of allografted patients were diagnosed a PTLD. Its clinical course was highly aggressive, and prognosis poor, especially in those failing rituximab. The prognostic impact found of the platelet, and lymphocyte count at diagnosis requires further confirmation.
Post-transplant lymphoproliferative disorder (PTLD) is an infrequent complication of allogeneic stem cell transplant (allo-SCT). AIMS: To estimate the frequency and management of PTLD in Spain and to identify prognostic factors influencing outcomes. METHODS: Multicenter, retrospective analysis of allo-SCT performed in 14 transplant units over a 15-year period. RESULTS: 102 PTLD were diagnosed among 12 641 allo-SCT, leading to an estimated frequency of 0.8%. PTLD was diagnosed at a median of 106 days after SCT. Eighty-seven cases (85%) were diagnosed between 2007 and 2013. At diagnosis, 22% and 17% of the patients had gastrointestinal tract and CNS involvement. Eighty-seven (85%) received rituximab treatment, alone or in combination with immunosuppression reduction, with an ORR of 50.6%. With a median follow-up for survivors of 58 months, the 2-year overall survival (OS) was 33% and the PTLD-related mortality 45%. Age ≥ 40 years, malignant underlying disease, non-response to rituximab, and severe thrombocytopenia or lymphocytopenia at PTLD diagnosis were associated with worse overall survival. CONCLUSIONS: Only a small proportion of allografted patients were diagnosed a PTLD. Its clinical course was highly aggressive, and prognosis poor, especially in those failing rituximab. The prognostic impact found of the platelet, and lymphocyte count at diagnosis requires further confirmation.
Authors: Anna Füreder; Gabriele Kropshofer; Martin Benesch; Michael Dworzak; Sabine Greil; Wolf-Dietrich Huber; Holger Hubmann; Anita Lawitschka; Georg Mann; Ina Michel-Behnke; Thomas Müller-Sacherer; Herbert Pichler; Ingrid Simonitsch-Klupp; Wolfgang Schwinger; Zsolt Szepfalusi; Roman Crazzolara; Andishe Attarbaschi Journal: Cancer Rep (Hoboken) Date: 2021-03-23