TY - JOUR
T1 - Management and Outcomes of Diffuse Large B-cell Lymphoma Post-transplant Lymphoproliferative Disorder in the Era of PET and Rituximab
T2 - A Multicenter Study From the Australasian Lymphoma Alliance
AU - Boyle, Stephen
AU - Tobin, Joshua W. D.
AU - Perram, Jacinta
AU - Hamad, Nada
AU - Gullapalli, Veena
AU - Barraclough, Allison
AU - Singaraveloo, Lydia
AU - Han, Min-Hi
AU - Blennerhassett, Richard
AU - Nelson, Niles
AU - Johnston, Anna M.
AU - Talaulikar, Dipti
AU - Karpe, Krishna
AU - Bhattacharyya, Abir
AU - Cheah, Chan Yoon
AU - Subramoniapillai, Elango
AU - Bokhari, Waqas
AU - Lee, Cindy
AU - Hawkes, Eliza A.
AU - Jabbour, Andrew
AU - Strasser, Simone
AU - Chadban, Steven J.
AU - Brown, Christina
AU - Mollee, Peter
AU - Hapgood, Greg
PY - 2021/11
Y1 - 2021/11
N2 - There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5-14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
AB - There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5-14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
KW - SOLID-ORGAN TRANSPLANTATION
KW - POSITRON-EMISSION-TOMOGRAPHY
KW - INITIAL THERAPY
KW - R-CHOP
KW - IMMUNOSUPPRESSION
KW - REDUCTION
KW - PTLD
KW - CHEMOTHERAPY
KW - TRIAL
KW - RISK
U2 - 10.1097/HS9.0000000000000648
DO - 10.1097/HS9.0000000000000648
M3 - Article
C2 - 34651103
SN - 2572-9241
VL - 5
SP - E648
JO - HemaSphere
JF - HemaSphere
IS - 11
M1 - 648
ER -