First -line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: Retrospective, single-centre study
Martínez-Calle N (1), Alfonso A (1), Rifón J (1), Herrero I (2), Errasti P [SP] (3), Rábago G (4), Merino J [SP] (5), Panizo Á (6), Pardo J [SP] (6), Prósper F (1), García-Muñoz R (7), Lecumberri R [SP](1), Panizo C (1).
(1) Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
(2) Hepatology Department, Clínica Universidad de Navarra, Pamplona, España.
(3) Nephrology Department, Clínica Universidad de Navarra, Pamplona, España.
(4) Cardiac Surgery Department, Clínica Universidad de Navarra, Pamplona, España.
(5) Immunology Department, Clínica Universidad de Navarra, Pamplona, España.
(6) Clinical Department of Pathology, Clínica Universidad de Navarra, Pamplona, España.
(7) Hematology Department, Hospital san Pedro de Logroño, La Rioja, España.
Magazine: European Journal of Haematology
Date: May 27, 2016Hepatology Nephrology [SP] Haematology and Hameotherapy Pathological Anatomy [SP] Cell Therapy Area [SP] Cardiac Surgery [SP] Immunology [SP]
This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients were included.
Survival was analysed taking into account PTLD type (monomorphic vs polymorphic), EBV infection status, IPI score, Ann Arbor stage, and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 years (range 29-69), median time to diagnosis 50 months (Range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; p=0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab).
Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (p=0.01; CI95% rituximab 58-79 months; non-rituximab 1-30 months).
Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for Cyclosporine A (CyA), which associated with increased time to PTLD (p=0.02). Rituximab was associated with increased survival in our single-centre series, and should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.
CITATION Eur J Haematol. 2016 May 27. doi: 10.1111/ejh.12782
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