Single-center analysis of biopsy-confirmed posttransplant lymphoproliferative disorder: incidence, clinicopathological characteristics and prognostic factors

Abstract

Hematopoietic stem cell and solid organ transplant recipients diagnosed with biopsy-confirmed posttransplant lymphoproliferative disorder (PTLD) at our institution from 1989 to 2010 were identified. Patient-, transplant- and disease-related characteristics, prognostic factors and outcome were collected and analyzed. One hundred and forty biopsy-proven cases of PTLD were included. Overall incidence in the transplant population was 2.12%, with heart transplant recipients carrying the highest risk. Most PTLDs were monomorphic (82%), with diffuse large B-cell lymphoma being the most frequent subtype. The majority of cases (70.7%) occurred > 1 year posttransplant, and 66% were Epstein-Barr virus positive. Following initial therapy the overall response rate was 68.5%. Three-year relapse-free and overall survivals were 59% and 49%, respectively. At last follow-up, 44% of the patients were alive. Multivariable analysis identified several classical lymphoma-specific poor prognostic factors for the different outcome measures. The value of the International Prognostic Index was confirmed in our analysis.

Untitled

“…The time from transplant to diagnosis of PTLD typically was < 1 year in early reports and longer in more recent studies. 11 In the present study, most patients were diagnosed with PTLD > 1 year after transplant.…”

Post-transplant lymphoproliferative disorder presenting with skin ulceration in a renal transplant recipient who achieved sustained remission with rituximab therapy: A case report

“…The risk factors for developing PTLD include EBV serostatus (higher risk of developing PTLD when an EBV seronegative organ recipient receives an organ from a seropositive donor), type of organ transplant, intensity of immunosuppression and age: There is a higher incidence of PTLD among extrarenal transplant recipients (5-7); the incidence of PTLD is highest with haploidentical hematopoietic stem cell transplant (HSCT), heart/lung and multivisceral transplants (≤20%), followed by liver (4.5%), combination heart-lung (2.5%), pancreas (2%), kidney (1-1.5%) and matched related and unrelated HSCT (0.5-1%) (7,8); in addition, pediatric patients are at greater risk compared with adults (5).…”

Untitled

“…3 In our series, most malignancies were categorized as PTLD, which typically occurs with advanced disease and frequent extranodal involvement. 4 Our previous study showed that 33% patients were diagnosed with nodal PTLD. 5 The risk of Kaposi sarcoma in transplant recipients parallels Human herpesvirus 8 (HHV-8) seroprevalence in different countries and regions.…”