Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab.
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| Abstract |
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B-cell, T/NK-cell, and T-cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B-cell lymphoma. Thirty-one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post-HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio [HR] = 5.6, 95% confidence interval [CI], 1.48-21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61-12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26-7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post-HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG-), 0.75% (rituximab-, ATG-), 1.25% (rituximab+, ATG+), and 3.53% (rituximab-, ATG+). Regarding lymphoma subtypes, patients with mature B-cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high-risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high-risk patients.
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| Authors | Ayumi Fujimoto, Nobuhiro Hiramoto, Satoshi Yamasaki, Yoshihiro Inamoto, Masao Ogata, Yasuhiro Sugio, Takahiro Fukuda, Naoyuki Uchida, Kazuhiro Ikegame, Ken-Ichi Matsuoka, Souichi Shiratori, Tadakazu Kondo, Toshihiro Miyamoto, Tetsuya Eto, Tatsuo Ichinohe, Yoshinobu Kanda, Yoshiko Atsuta, Ritsuro Suzuki, Complication Working Group of the Japan Society for Hematopoietic Cell Transplantation |
| Journal | Hematological oncology (Hematol Oncol) Vol. 38 Issue 2 Pg. 146-152 (Apr 2020) ISSN: 1099-1069 [Electronic] England |
| PMID | 31953867 (Publication Type: Journal Article, Multicenter Study) |
| Copyright | © 2020 John Wiley & Sons Ltd. |
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