Post-transplant lymphoproliferative disorder (PTLD): single institutional experience of 141 patients

Rohit Bishnoi; Ravneet Bajwa; Aaron J Franke; William Paul Skelton 4th; Yu Wang; Niraj M Patel; William Birdsall Slayton; Fei Zou; Nam H Dang

doi:10.1186/s40164-017-0087-0

Post-transplant lymphoproliferative disorder (PTLD): single institutional experience of 141 patients

Exp Hematol Oncol. 2017 Sep 29:6:26. doi: 10.1186/s40164-017-0087-0. eCollection 2017.

Authors

Rohit Bishnoi¹, Ravneet Bajwa², Aaron J Franke³, William Paul Skelton 4th³, Yu Wang⁴, Niraj M Patel³, William Birdsall Slayton⁵, Fei Zou⁴, Nam H Dang²

Affiliations

¹ Department of Medicine, University of Florida, PO Box 100238, Gainesville, FL 32610-0238 USA.
² Department of Medicine, University of Florida, PO Box 100278, 1600 SW Archer Rd, Gainesville, FL 32610 USA.
³ Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL 32610-0277 USA.
⁴ Department of Biostatistics, University of Florida, PO Box 117450, Gainesville, FL 32611 USA.
⁵ Division of Pediatric Hematology/Oncology, University of Florida, PO Box 100298, Gainesville, FL 32610-0298 USA.

Abstract

Background: Post-transplant lymphoproliferative disorder is a well-recognized but rare complication of hematopoietic stem cell and solid organ transplant. Due to rarity of this disease, retrospective studies from major transplant centers has been the main source to provide treatment guidelines, which are still in evolution. The sample size of this study is among one of the largest study on PTLD till date reported throughout the world.

Methods: This study was performed at University of Florida which is one of the largest transplant center in South East United States. We performed treatment and survival analysis along with univariate and multivariate analysis to identify prognostic factors.

Results: We reviewed 141 patients diagnosed with PTLD over last 22 years with median follow-up of 2.4 years. The estimated median overall survival of the entire group was 15.0 years. Sub group analysis showed that 5-year overall survival rates of pediatric population were 88% (median not reached). For adults, median OS was 5.35 years while for elderly patients it was 1.32 years. The estimated median OS of patients with monomorphic PTLD was 9.0 years while in polymorphic PTLD was 19.3 years. Univariate analysis identified gender, age at transplant and PTLD diagnosis, performance status, IPI score, allograft type, recipient EBV status, multiple acute rejections prior to PTLD diagnosis, PTLD sub-type, extra-nodal site involvement, immunosuppressive drug regimen at diagnosis, initial treatment best response were statistically significant prognostic factors (p < 0.05). On multivariate analysis, age at PTLD diagnosis, recipient EBV status, bone marrow involvement, and initial best response were statistically significant prognostic factors (p < 0.05). Surprisingly, use of Rituximab alone as upfront therapy had poor hazard ratio in the cumulative group as well less aggressive PTLD subgroup comprising of early lesions and polymorphic PTLD.

Conclusions: Our experience with treatment and analysis of outcomes does challenge current role of Rituximab use in treatment of PTLD. Currently as we define role of immunotherapy in cancer treatment, the role of acute rejections and immunosuppressant in PTLD becomes more relevant as noticed in our study. This study was also able to find new prognostic factors and also verified other known prognostic factors.

Keywords: EBV PTLD; PTLD; Post-transplant lymphoproliferative disorder; Prognostic factors for PTLD; Rituximab for PTLD.