Outcomes and a New Prognostic Model in Posttransplantation Lymphoproliferative Disorders (PTLD): Intent-to-Treat (ITT) Analysis of 81 Patients in the Post-Rituximab Era.

The outcome of PTLD has a reported approximate 3-year (yr) overall survival (OS) rate of 35%–40% in the pre-RTX era (JCO2001; 19:772). The impact, if any, of RTX on the prognosis or outcome of PTLD is not known. We retrospectively studied the clinical features, treatment, outcomes (ITT), and prognostic factors among a large multi-center cohort of solid organ transplantation (SOT)-related PTLD cases over a 10-yr period in the post-RTX era (1/98–2/08) at 4 Chicago academic institutions. Prognostic factors were evaluated in Cox proportional hazards regression for indicators of progression-free survival (PFS) and OS. 81 pts were identified with a median age at PTLD diagnosis (dx) 48 yrs (range, 20–72) and median time from SOT to PTLD dx 42 months (mo) (range, 1-216 mo). EBV+ PTLD pts more commonly were treated by concurrent reduction of immune suppression (median reduction 75%) with single agent RTX whereas EBV-neg pts more frequently received RTX/chemotherapy with median immune suppression reduction of 90%. On ITT (median follow-up 36 mo), the 3-yr PFS for all pts was 58% and 3-yr OS was 62%. Of note, 13/81 (16%) pts died ≤6 weeks from PTLD dx, primarily due to progressive disease. Univariate analysis found several factors highly predictive of outcome (Table 1): performance status (PS), serum albumin, >1 extranodal (EN) site, bone marrow (BM) involvement, CNS disease, and RTX as part of initial therapy (alone or combined with chemotherapy). Neither EBV status nor time to PTLD predicted outcome. Table 1. PTLD characteristics and univariate predictors of EFS and OS (n=81). Table 2. Three-year survival (Kaplan-Meier) based on prognostic variables (univariate).