Post-Transplant Lymphoproliferative Disorders after Heart or Kidney Transplantation at a Single Centre: Presentation and Response to Treatment

Abstract

Post-transplant lymphoproliferative disorders (PTLD) is a serious complication after solid organ transplantation. Reduction of immunosuppression (RI) alone is not able to control the disease. We report a prospective analysis of 30 patients with PTLD after heart or kidney transplantation. Only 5 of 30 patients, treated solely with RI, obtained a complete response. Five patients were treated heterogeneously; in the remaining 20, the efficacy and safety of a weekly anthracycline-based chemotherapy were assessed. Sixteen patients obtained a complete remission. One death was related to treatment. With a median follow-up of 36 months, 3-year overall survival was 63.3% and 57% for the entire group and the chemotherapy-treated group, respectively. Moreover, 4 second neoplasms were observed in the chemotherapeutic group. In this study, we demonstrated that most PTLD need other treatment than RI and a weekly regimen is manageable and has a favourable impact on long-term survival.

Reduction of Immunosuppression as Initial Therapy for Posttransplantation Lymphoproliferative Disorder★

“…Complete response rates following RI are reported between 0–74%; this wide range likely reflects heterogeneity of patient populations and the non-standardized management of RI. Retrospective studies reveal that in many centers the proportion of patients who are managed with RI alone is low and often chemotherapy and/or rituximab are administered up front(12, 15, 19–21). In this report, we describe the response rates to RI when used alone as initial therapy for PTLD and determine predictors of response and survival.…”

“…Previous attempts to define the efficacy and safety of RI for PTLD remain of limited value due to small numbers of patients (12)(13)(14)(15)(16)(17)(18). Complete response rates following RI are reported between 0% and 74%; this wide range likely reflects heterogeneity of patient populations and the nonstandardized management of RI.…”

Post-Trasplant Lymphoproliferative Disorders (PTLD) in Adult Kidney Trasplantated Patients

“…Chemotherapy is commonly used in the treatment of PTLD when reduction in immunosuppression fails to control the disease. Various multi-drug regimens such as CHOP or CHOP like (cyclophosphamide, doxorubicin, vincristine and prednisone) have been used in PTLD patients (Wasson et al, 2006;Elstrom et al, 2006;Trappa et al, 2007;Taylor et al, 2006;Fohrer et al, 2006;Baudi et al, 2007;Patel et al, 2007;Aversa et al, 2008) (table 4). In spite of the high RR up to 70%, the associated toxicity is significant and includes treatment-related deaths in about 25% of patients.…”

Posttransplant Lymphoproliferative Disorders in Neuronal Xenotransplanted Macaques

“…9 They comprise a wide spectrum of clinical and pathological manifestations ranging from a benign self-limited form of lymphoproliferation to an aggressive and disseminated lymphoma. 2 PTLD incidence is as high as 10% in solid organ transplantation 4 and may occur at any time after transplantation, but the risk appears to be greatest within the first year posttransplantation. 19 PTLD World Health Organization (WHO) classification recognizes 3 main pathologic subsets of the lymphoproliferative lesions: early, polymorphic, and monomorphic lesions.…”