Hodgkin lymphoma post‐transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival

Abstract

Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL-PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL-SEER). Overall survival (OS) and disease-specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL-PTLD diagnosis was 88 months. When compared with HL-SEER, patients with HL-PTLD were older (median age, 52 vs. 36 years, P 5 0.001), more likely male (73% vs. 54%, P < 0.001), Caucasian (81% vs. 70%, P 5 0.02), and had extranodal disease (42% vs. 3%, P < 0.001). Five-year OS for patients with HL-PTLD was 57% versus 80% for HL-SEER (P < 0.001); DSS was also inferior (P < 0.001). For patients with HL-PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR 5 0.36, P < 0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR 5 2.94, P 5 0.001 and 2.01, P 5 0.04) versus HL-specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR 5 1.26/decade P < 0.001 and 1.64/0.1 mg/dL increase P 5 0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10-year OS rates of 79%, 53%, and 11%, respectively (P < 0.001). Altogether, HL-PTLD patients have inferior survival when compared with HL-SEER. Furthermore, treatment with HL-specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival.

Primary Intestinal Hodgkin Lymphoma Mimicking Intraabdominal Abscess in a Renal Transplant Recipient: A Case Report

“…A significantly longer median OS was found in the patients who received an HL-specific regimen compared to the patients who received no chemotherapy, CHOP, and non-traditional chemotherapeutic regimens (not reached vs. 15, 93, and 88 months, respectively; p < 0.001) [11]. It remains unclear why such a considerable proportion of patients (57%) did not receive HL-specific chemotherapy in the described group.…”

“…Primary extranodal HL appears extremely rare in general, comprising 1-3% of HL patients, the most common being primary gastrointestinal involvement [11,12]. 7 patients with HL of the small intestine were identified in the literature review among 778 gastrointestinal lymphomas from 9 case series.…”

“…Rosenberg et al [11] recently compared features between 192 patients with HL/PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (Surveillance, Epidemiology, and End Results Program; HL-SEER). In this largest cohort of HL/PTLD patients reported so far, 145 of the 192 patients were recorded to have received chemotherapy, most of them an HL-specific regimen (most commonly ABVD/ABVD-like regimens, n = 63, 43%).…”

“…It was recently reported that a relatively large proportion of patients with HL/PTLD (n = 80/192, 42%) exhibited extranodal disease at diagnosis, compared to a significantly lower rate in the HL/non-PTLD group (n = 332/12,819, 3%, p < 0.001). Furthermore, patients with HL/PTLD tend to be older (median age 52 vs. 36 years, p = 0.001), more likely male (73 vs. 54%, p < 0.001) and Caucasian (81 vs. 70%, p = 0.02) [11]. …”

“…Nevertheless, a shorter OS in the HL/PTLD group compared to solid organ transplant naive patients was conclusively demonstrated (5-year OS 57 vs. 78%, p < 0.001), but it also underlined the fact that mortality due to other causes was significantly higher in patients with HL/PTLD (5-year cumulative incidences of 20 vs. 6%, respectively, p < 0.001). The multivariable analysis singled out older patients with elevated creatinine as a particularly vulnerable population [11]. …”