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Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution

Item Type:Article
Title:Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution
Creators Name:Choquet, S. and Oertel, S. and Leblond, V. and Riess, H. and Varoqueaux, N. and Doerken, B. and Trappe, R.
Abstract:The introduction of single-agent rituximab has markedly changed the approach to therapy of patients with post-transplantation lymphoproliferative disorder (PTLD), but response to treatment varies substantially between patients. In the current report, we analyze long-term efficacy of single-agent rituximab in 60 patients and present factors predictive of progression-free and overall survival. Twelve months after completing first-line treatment, 34 of 60 patients (57%) had progressive disease, resulting in a median progression-free survival of 6.0 months at a median follow-up of 16.3 months. Using multivariate Cox regression analysis, the following factors were identified as significantly predictive of overall survival: age at diagnosis, performance status, lactate dehydrogenase (LDH), and time from transplantation to PTLD. Stage of disease and Epstein-Barr virus association of PTLD did not influence overall survival. LDH and time from transplantation to PTLD were also predictive of progression-free survival. The international prognostic index was shown to be of limited predictive value in these patients, but a PTLD-specific prognostic index separated low-, intermediate-, and high-risk patients with high significance: 2-year overall survival rates after first-line treatment with single-agent rituximab were 88, 50, and 0%, respectively. Thus, prognostic indices can be useful tools for prediction of treatment outcome and for the development of risk-adapted treatment strategies in patients with PTLD and may also provide the basis for interstudy comparisons.
Keywords:PTLD, Rituximab, Prognosis, Prognostic factors, IPI, Risk adapted therapy, Chemotherapy
Source:Annals of Hematology
ISSN:0939-5555
Publisher:Springer (Germany)
Volume:86
Number:8
Page Range:599-607
Date:August 2007
Official Publication:https://doi.org/10.1007/s00277-007-0298-2
PubMed:View item in PubMed

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