Validation of a Post-Transplant Lymphoproliferative Disorder Risk Prediction Score and Derivation of a New Prediction Score Using a National Bone Marrow Transplant Registry Database

Abstract

Background. We externally validated Fujimoto's Post-Transplant Lymphoproliferative Disorder (PTLD) scoring system for risk prediction by using the Taiwan Blood and Marrow Transplant Registry Database (TBMTRD), and aimed to create a superior scoring system using machine learning methods. Materials and Methods. Consecutive allogeneic hematopoietic cell transplant (HCT) recipients registered in the TBMTRD from 2009 to 2018 were included in this study. The Fujimoto PTLD score was calculated for each patient. The machine learning algorithm, LASSO, was used to construct a new score system, which was validated using the 5-fold cross validation method.Results. We identified 2,148 allogeneic HCT recipients, of which 57 (2.65%) developed PTLD in the TBMTRD. In this population, the probability for PTLD development by Fujimoto score at five years for patients in the low, intermediate, high and very high-risk groups were 1.15%, 3.06%, 4.09%, 8.97%, respectively. The score model had acceptable discrimination with a C-statistic of 0.65 and a near-perfect moderate calibration curve (HL test P of 0.81). Using LASSO regression analysis, a four-risk-group model was constructed and the new model showed better discrimination in the validation cohort when compared with The Fujimoto PTLD score (C-statistic: 0.75 vs. 0.65). Conclusion.Our study demonstrated a more comprehensive model when compared with Fujimoto's PTLD scoring

A Case of Central Nervous System Post-Transplant Lymphoproliferative Disorder Following Haploidentical Stem Cell Transplantation in a Patient With Acute Lymphoblastic Leukemia

“…Different from the risk factors for IEMR after allo-HSCT, the risk factors for EBV-positive PTLD are 9 ATG in a conditioning regimen and ATG in treatment of acute GVHD, non-HLA-matched related donor, aplastic anemia, second or subsequent allo-HSCT, allo-HSCT in the last year, and aGVHD. Another study constructed a risk stratification tool to identify patients at high risk for PTLD 19 . The tool assigns points for different risk factors: ATG use in conditioning regimen (high dose: 2 points, low dose: 1 point), donor type (HLA-mismatched related donor: 1 point, unrelated donor: 1 point, cord blood: 2 points), and a diagnosis of aplastic anemia (1 point).…”

Epstein–Barr Virus Monitoring after an Allogeneic Hematopoietic Stem Cell Transplant: Review of the Recent Data and Current Practices in Canada

“…Recently, Che et al validated Fujimoto's PTLD scoring system and confirmed the acceptable discrimination of the system in a retrospective study of another cohort (n = 2148). They proposed to include additional predictors and showed that their new risk-group model (Lee's LASSO score from 0 to 12) has better discrimination to identify high-risk patients [44]. Using these promising risk stratifications could help identify higher-risk patients who could benefit from more frequent or longer monitoring or universal prophylaxis.…”

Recent advancements in hematopoietic stem cell transplantation in Taiwan

“…A 2021 analysis of the TBMTR database by Lee et al [ 22 ] revealed that of the 2,148 cases that underwent allo-HSCT between 2009 and 2018, 57 (2.65%) developed PTLD. In this group, based on the Fujimoto scoring system, the probability of developing PTLD after 5 years was 1.15%, 3.06%, 4.09%, and 8.97% for the low-, intermediate-, high-, and very high-risk groups, respectively.…”