Incidence and outcomes of post-transplant lymphoproliferative disease after 5365 solid-organ transplants over a 20-year period at two UK transplant centres.

Autor: Santarsieri A; Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.; Anglia Ruskin University, Cambridge, UK., Rudge JF; Bullard Laboratories, University of Cambridge, Cambridge, UK., Amin I; Department of General Surgery, Addenbrooke's Hospital, Cambridge, UK., Gelson W; Department of Hepatology, Addenbrooke's Hospital, Cambridge, UK., Parmar J; Cardio-Thoracic Transplant Unit, Royal Papworth Hospital, Cambridge, UK., Pettit S; Cardio-Thoracic Transplant Unit, Royal Papworth Hospital, Cambridge, UK., Sharkey L; Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK., Uttenthal BJ; Department of Haematology, Addenbrooke's Hospital, Cambridge, UK., Follows GA; Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.; Anglia Ruskin University, Cambridge, UK.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2022 May; Vol. 197 (3), pp. 310-319. Date of Electronic Publication: 2022 Mar 02.
DOI: 10.1111/bjh.18065
Abstrakt: Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of solid-organ transplantation (SOT). We present the incidence and outcomes of PTLD in a cohort of 5365 SOT recipients over a 20-year period at two UK transplant centres. With a median follow-up of 7.7 years, 142 of 5365 patients have developed PTLD. Cumulative incidence was 18% at five years after multivisceral transplant and 1%-3% at five years following the other SOT types. Twenty-year cumulative incidence was 2%-3% following liver and heart transplantation and 10% following kidney transplantation. Median overall survival (OS) following SOT was 16 years, which is significantly reduced compared with the age-adjusted UK population. There is relatively high early mortality following diagnosis of PTLD and only patients surviving two years regained a longer-term survival approaching the non-PTLD SOT cohort. Of 90 patients with monomorphic PTLD, diffuse large B-cell lymphoma, 66 were treated with first-line rituximab monotherapy and 24 received first-line rituximab plus chemotherapy. Up-front rituximab monotherapy does not appear to compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. Multivariate analysis of all 90 monomorphic PTLD patients identified an International Prognostic Index (IPI) of 3+ as the strongest pretreatment variable associating with inferior one-year OS.
(© 2022 British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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