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Eur J Haematol. 2019 Jun;102(6):465-471. doi: 10.1111/ejh.13226. Epub 2019 Apr 10.

Frequency, characteristics, and outcome of PTLD after allo-SCT: A multicenter study from the Spanish group of blood and marrow transplantation (GETH).

Author information

1
Department of Hematology of the: Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Autonomous University of Barcelona, Barcelona, Spain.
2
HU. Marqués de Valdecilla, Santander, Spain.
3
Hospital La Fe, Valencia, Spain.
4
HU. Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain.
5
Hospital Vall d'Hebrón, Barcelona, Spain.
6
Hospital Gregorio Marañón, Madrid, Spain.
7
Hospital Reina Sofía, Cordoba, Spain.
8
Hospital Clínic Barcelona, Barcelona, Spain.
9
Hospital Niño Jesús, Barcelona, Spain.
10
Hospital Morales Meseguer, Murcia, Spain.
11
Complejo Hospitalario de Navarra, Pamplona, Spain.
12
H. Germans Trias i Pujol, Barcelona, Spain.
13
H. Clínico Universitario de Salamanca, Salamanca, Spain.
14
H. Ramón y Cajal, Madrid, Spain.
15
Hospital Clínico de Valencia, Valencia, Spain.

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is an infrequent complication of allogeneic stem cell transplant (allo-SCT).

AIMS:

To estimate the frequency and management of PTLD in Spain and to identify prognostic factors influencing outcomes.

METHODS:

Multicenter, retrospective analysis of allo-SCT performed in 14 transplant units over a 15-year period.

RESULTS:

102 PTLD were diagnosed among 12 641 allo-SCT, leading to an estimated frequency of 0.8%. PTLD was diagnosed at a median of 106 days after SCT. Eighty-seven cases (85%) were diagnosed between 2007 and 2013. At diagnosis, 22% and 17% of the patients had gastrointestinal tract and CNS involvement. Eighty-seven (85%) received rituximab treatment, alone or in combination with immunosuppression reduction, with an ORR of 50.6%. With a median follow-up for survivors of 58 months, the 2-year overall survival (OS) was 33% and the PTLD-related mortality 45%. Age ≥ 40 years, malignant underlying disease, non-response to rituximab, and severe thrombocytopenia or lymphocytopenia at PTLD diagnosis were associated with worse overall survival.

CONCLUSIONS:

Only a small proportion of allografted patients were diagnosed a PTLD. Its clinical course was highly aggressive, and prognosis poor, especially in those failing rituximab. The prognostic impact found of the platelet, and lymphocyte count at diagnosis requires further confirmation.

KEYWORDS:

EBV; PTLD; allo-SCT; infection; rituximab

PMID:
30828868
DOI:
10.1111/ejh.13226
[Indexed for MEDLINE]

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