title: Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution.
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.
authors.affiliation: Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Choquet
authors.forename: Stephan
authors.initials: S
authors.lastname: Oertel
authors.forename: Veronique
authors.initials: V
authors.lastname: LeBlond
authors.forename: Hanno
authors.initials: H
authors.lastname: Riess
authors.forename: Nathalie
authors.initials: N
authors.lastname: Varoqueaux
authors.forename: Bernd
authors.initials: B
authors.lastname: Dörken
authors.forename: Ralf
authors.initials: R
authors.lastname: Trappe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab