title: Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation.
abstract: We evaluated 26 901 patients who underwent allogeneic hematopoietic cell transplantation (HCT) at 271 centers worldwide to define patterns of posttransplantation lymphoproliferative disorders (PTLDs). PTLDs developed in 127 recipients, with 105 (83%) cases occurring within 1 year after transplantation. In multivariate analyses, we confirmed that PTLD risks were strongly associated (P < .001) with T-cell depletion of the donor marrow, antithymocyte globulin (ATG) use, and unrelated or HLA-mismatched grafts (URD/HLA mismatch). Significant associations were also confirmed for acute and chronic graft-versus-host disease. The increased risk associated with URD/HLA-mismatched donors (RR = 3.8) was limited to patients with T-cell depletion or ATG use (P = .004). New findings were elevated risks for age 50 years or older at transplantation (RR = 5.1; P < .001) and second transplantation (RR = 3.5; P < .001). Lower risks were found for T-cell depletion methods that remove both T and B cells (alemtuzumab and elutriation, RR = 3.1; P = .025) compared with other methods (RR = 9.4; P = .005 for difference). The cumulative incidence of PTLDs was low (0.2%) among 21 686 patients with no major risk factors, but increased to 1.1%, 3.6%, and 8.1% with 1, 2, and more than 3 major risk factors, respectively. Our findings identify subgroups of patients who underwent allogeneic HCT at elevated risk of PTLDs for whom prospective monitoring of Epstein-Barr virus activation and early treatment intervention may be particularly beneficial.
authors.affiliation: Division of Cancer Epidemiology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA. landgreo@mail.nih.gov
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Gilbert
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Peter M
authors.initials: PM
authors.lastname: Banks
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Sobocinski
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Jaffe
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Kingma
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
authors.forename: Mary E
authors.initials: ME
authors.lastname: Flowers
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Curtis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D055815:Young Adult