title: Clinical and pathological prognostic markers for survival in adult patients with post-transplant lymphoproliferative disorders in solid transplant.
abstract: We sought to determine the clinical and immunohistopathological prognostic factors for overall survival (OS) in adult patients with post-transplant lymphoproliferative disorders (PTLDs). Eighty-four patients diagnosed with PTLDs between 1980 and 2004 at the University of Pittsburgh Medical Center were identified. Immunohistochemical staining was performed on tumor tissue at the time of diagnosis for the following proteins: Bcl-2, Bcl-6, c-myc and p53. The median survival for all patients was 20.8 months, 95% CI: (7.4-77.6). On univariate analysis for OS, the following poor prognostic factors were identified: age at transplant >60 years (p = 0.024), multiorgan transplant (p = 0.019), ECOG > 2 (p < 0.0001), grafted organ involvement (p < 0.0001), extranodal disease (p = 0.011), early (<1 year) PTLDs (p < 0.0001), stage IV (p = 0.0017), EBV positive (p = 0.012) and elevated white blood count (p = 0.010). Good prognostic factors included ECOG<2 (p < 0.0001), late (>1 year) PTLDs (p = 0.002), early stage at diagnosis (stages I and II, p = 0.005), nodal disease (p = 0.0053), monomorphic disease (0.0034), initial immunosuppression reduction (p = 0.0015) and use of rituximab (p = 0.045). Bcl-2 but not Bcl-6, c-myc, or p53 correlated with poor survival, p = 0.0036. This study identifies new clinical and pathological markers for poor survival in PTLDs.
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Ana B
authors.initials: AB
authors.lastname: Oton
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.forename: Xavier
authors.initials: X
authors.lastname: Leleu
authors.forename: Mona F
authors.initials: MF
authors.lastname: Melhem
authors.forename: Diane
authors.initials: D
authors.lastname: George
authors.forename: Ann
authors.initials: A
authors.lastname: Lacasce
authors.forename: Kenneth
authors.initials: K
authors.lastname: Foon
authors.forename: Irene M
authors.initials: IM
authors.lastname: Ghobrial
mesh_terms: D015415:Biomarkers / Q000032:analysis; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D051560:Proto-Oncogene Proteins c-bcl-6 / Q000032:analysis; D016271:Proto-Oncogene Proteins c-myc / Q000032:analysis; D012307:Risk Factors; D016019:Survival Analysis; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D015415:Biomarkers; C489427:MYC protein, human; D019253:Proto-Oncogene Proteins c-bcl-2; D051560:Proto-Oncogene Proteins c-bcl-6; D016271:Proto-Oncogene Proteins c-myc; D016159:Tumor Suppressor Protein p53