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

Abstract

Summary 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.

Outcomes of children treated for multiple Epstein–Barr virus‐associated post‐transplant tumors

“…Prior studies have reported relapse rates of about 20% 11 but progression and relapse rates may be higher in adults. 12,13 In this cohort, repeated episodes of EBV-associated disease were often detected on scans prior to patients becoming clinically symptomatic. The role of PET imaging in PTLD is still not clearly defined due to small numbers of patients evaluated in studies focused on its utility.…”

“…Relapsed PTLD in pediatric recipients of SOT is not uncommon. Prior studies have reported relapse rates of about 20% 11 but progression and relapse rates may be higher in adults 12,13 …”

Characteristics and Outcome of Post-Transplant Lymphoproliferative Disorders After Solid Organ Transplantation: A Single Center Experience of 196 Patients Over 30 Years

“…However, we observed a significant relation between EBV status and OS in PT-DLBCL, with clinically meaningful improved survival in EBV(-) PT-DLBCL compared to EBV(+) PT-DLBCL (8.8 years versus 2.5 years, respectively). Previous reports have shown conflicting results on the relation between EBV status and OS ( 13 , 14 , 18 , 25 , 50 , 57 , 58 ).…”

Epstein–Barr virus‐associated lymphomas decoded

“…The incidence varies from 1% to 18% of organ transplant recipients depending on the organ transplanted and the depth and duration of immunosuppression, with the highest incidence in lung and then intestinal transplantation, followed by heart, liver and kidney. 49 The WHO (Table 1) 50 recognises distinct histological subtypes ranging from less overtly malignant processes (plasmacytic hyperplasia, IM and florid follicular hyperplasia) through to polymorphic PTLD (comprised of lymphoid cells of varying sizes and morphologies), cHL PTLD and finally monomorphic PTLD, which shows a more homogenous lymphoid infiltrate and comprises the majority of cases. Within monomorphic PTLD, the disease is further categorised by the disease it morphologically resembles; typically, cases are monomorphic-DLBCL PTLD.…”