title: Prognostic factors in patients with post-transplant lymphoproliferative disorders (PTLD) in the rituximab era.
abstract: To assess the effect of rituximab therapy and other prognostic factors on overall survival in patients with post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation, 30 consecutive patients diagnosed with PTLD between 1999 and 2002 were analyzed. Fifteen (50%) patients received rituximab (375 mg/m(2) once a week). Fifteen (50%) patients had other interventions including observation, immunosuppression reduction, surgery, chemotherapy, radiation or a combination of these. Patients receiving rituximab vs. non-rituximab differed in the following variables: age at diagnosis of PTLD (P = 0.009), days to PTLD (P = 0.0005), Epstein-Barr virus (EBV) in situ hybridization status (P = 0.02) and CD20-positive status (P = 0.006). At the time of last follow-up, 10 (33%) patients in the rituximab group and 5 (17%) in the non-rituximab group were alive. On univariate analysis for overall survival of all 30 patients, the significant factors were: treatment with rituximab (P = 0.03), response to treatment (P = 0.005), CD20 positive (P = 0.0004), low international prognostic index (IPI; P = 0.02) and good performance status (P = 0.009). Multivariate analysis of all patients was significant for CD20-positive status (P = 0.0007) and low performance status (P = 0.006). On multivariate analysis for overall survival in patients with CD20-positive PTLD, low IPI (P = 0.004) and rituximab therapy (P = 0.03) were significant. Low IPI and rituximab therapy led to an improved overall survival in patients with CD20-positive PTLD.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Ghobrial
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Kay M
authors.initials: KM
authors.lastname: Ristow
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: William
authors.initials: W
authors.lastname: Macon
authors.forename: Suzan M
authors.initials: SM
authors.lastname: Geyer
authors.forename: Christopher G
authors.initials: CG
authors.lastname: McGregor
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D000069283:Rituximab; D016019:Survival Analysis
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab