Reduction in Immunosuppression as Initial Therapy for Posttransplant Lymphoproliferative Disorder: Analysis of Prognostic Variables and Long-Term Follow-Up of 42 Adult Patients1

Tsai, Donald E.; Hardy, Cynthia; Tomaszewski, John E.; Kotloff, Robert M.; Oltoff, Kimberly M.; Somer, Bradley G.; Schuster, Stephen J.; Porter, David; Montone, Kathleen T.; Stadtmauer, Edward A.

doi:10.1097/00007890-200104270-00012

Cited by 332 publications

(282 citation statements)

References 24 publications

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“…Indeed, of the three patients treated with discontinuation of immune suppressive medications alone, two died as a result of disease progression before salvage treatments such as chemotherapy could be given. These results are in contrast to a study reported by Tsai et al [19] in which 19/30 patients (74%) responded to reduction of immune suppression. However, in a much larger series, (collated from the Cincinnati Transplant Tumor Registry) only 17% of 399 complete responders had been treated with reduction of immune suppression alone [20].…”

Section: Discussioncontrasting

confidence: 99%

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

et al. 2006

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Post-transplant lymphoproliferative disorders (PTLD) complicate up to 10% of solid organ transplants. This retrospective study was conducted to review the PTLD experience among 2,300 recipients of solid organ or allogeneic bone marrow transplants from a single institution. Twenty-seven cases of PTLD were identified, leading to an overall incidence of 1.2%. Polymorphic B cell hyperplasia/lymphoma was the most common type. The median time to development of PTLD was 8.4 months. Ten patients had localized (stage I or II) disease, and 12 patients presented with B symptoms. Nine patients each were treated with systemic chemotherapy or surgical resection as part of the initial therapy. After a median follow-up duration of 2.6 years, the median survival has not been reached. There were no late relapses of PTLD, and 17 patients remain alive. Age, sex, organ source, LDH, stage, presence of extranodal disease, or presentation with B symptoms did not influence overall survival when examined by Cox proportional hazard model. Thirteen patients retained their graft function throughout PTLD treatment. This study confirms the ability to treat a significant proportion of PTLD patients with chemotherapy or surgical resection (depending on presentation), without sacrificing graft function in those receiving chemotherapy. Am. J. Hematol. 82:208-214, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussioncontrasting

confidence: 99%

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

et al. 2006

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“…In agreement with our observation, two recent single-center studies similarly reported no effect of time to tumor development on patient survival (38,39). Several reports have suggested differences between the clinical and biological characteristics of lymphomas that develop early or late after transplantation.…”

Section: Lymphomas After Solid Organ Transplantationsupporting

confidence: 92%

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

977

787

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We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200 000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p < < 0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.

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“…In solid-organ transplantation, pharmacologic immunosuppression is highest in lung transplant patients in whom the incidence of PTLD approaches 10%. 15,16 Several factors have been identified in both solid-organ and stem cell transplants, which confer higher risk of developing PTLD (Table 2). In order to assess the role of T-cell immunity in the development of PTLD in allogeneic HST recipients, several groups have looked at immune reconstitution of EBV-specific cytotoxic T-cells post transplant.…”

Section: Authormentioning

confidence: 99%

Section: Solid-organ Transplantation Allogeneic Stem Cell Transplantamentioning

confidence: 99%

“…4,16 However, cases have been reported as early as 1 week and as late as 9 years post transplant. 16 Symptoms are diverse and may be related to viral infection, mass effect, organ dysfunction, or lymphoma-related B symptoms. Clinical features of PTLD in allogeneic HST recipients are similar to those of solid-organ transplant recipients, but there appears to be a greater incidence of fulminant, disseminated disease, perhaps accounting for the increased mortality seen in this population.…”

Section: Solid-organ Transplantation Allogeneic Stem Cell Transplantamentioning

confidence: 99%

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Post-transplant lymphoproliferative disorder: a review

Loren

Porter

Stadtmauer

et al. 2003

Bone Marrow Transplant

247

201

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Summary:Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of Epstein-Barr virus-related (EBV) clinical diseases, from a benign mononucleosis-like illness to a fulminant non-Hodgkin's lymphoma. In the setting of hematopoietic stem cell transplantation, PTLD is an often-fatal complication occurring relatively early after transplant. Risk factors for the development of PTLD are well established, and include HLA-mismatching, T-cell depletion, and the use of antilymphocyte antibodies as conditioning or treatment of graft-versushost disease. Early recognition of PTLD is particularly important in the SCT setting, because PTLD in these patients tends to be rapidly progressive. Familiarity with the clinical features of PTLD and a heightened level of suspicion are critical for making the diagnosis. Surveillance techniques with EBV antibody titers and/or polymerase chain raction (PCR) may have a role in some highrisk settings. Immune-based therapies such as monoclonal anti-B-cell antibodies, interferon-a, and EBV-specific donor T cells, either as treatment for PTLD or as prophylaxis in high-risk patients, represent promising new directions in the treatment of this disease.

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Reduction in Immunosuppression as Initial Therapy for Posttransplant Lymphoproliferative Disorder: Analysis of Prognostic Variables and Long-Term Follow-Up of 42 Adult Patients1

Abstract: Reduction in immunosuppression is an effective initial therapy for PTLD. Clinical prognostic factors may allow clinicians to identify which patients are likely to respond to reduction in immunosuppression.

Cited by 332 publications

References 24 publications

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Post-transplant lymphoproliferative disorder: a review

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