Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B‐cell, T/NK‐cell, and T‐cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B‐cell lymphoma. Thirty‐one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post‐HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio [HR] = 5.6, 95% confidence interval [CI], 1.48‐21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61‐12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26‐7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post‐HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG−), 0.75% (rituximab−, ATG−), 1.25% (rituximab+, ATG+), and 3.53% (rituximab−, ATG+). Regarding lymphoma subtypes, patients with mature B‐cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high‐risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high‐risk patients.

Epstein–Barr Virus-Induced Post-Transplant Lymphoproliferative Disorder of the Central Nervous System Successfully Treated with Chemo-Immunotherapy

“…In CNS-PTLD, it has been reported that time from transplantation to CNS-PTLD can be more than 10 years, and most CNS-PTLDs are associated with latent EBV infection [10]. In the case presented here, in addition to the profound immunosuppression associated with HSCT that triggered the reactivation of EBV infection and ultimately the malignant transformation of B cells, the patient was also subject to other factors, including the transplantation from an HLA-mismatched donor and the use of anti-thymocyte globulin that, based on previous reports, appear to increase the risk of PTLD [10,22].…”

Prevention of Oncogenic Gammaherpesvirinae (EBV and HHV8) Associated Disease in Solid Organ Transplant Recipients

“…The preemptive use of rituximab for prevention of PTLD has become a common strategy in EBV viremic hematologic stem-cell transplant (HSCT) [129,130]. B-cell depletion before or directly after HSCT, has shown to reduce EBV replication [131,132] and the incidence of EBV-positive PTLD [133][134][135] in high-risk patients. The potential effect of rituximab on subsequent PTLD development may be attributable to the depletion of CD20 + B-cells, which represent the major reservoir for latent EBV infection.…”