title: Late-onset post-transplantation lymphoproliferative disorders after kidney transplantation: a monocentric study over three decades.
abstract: BACKGROUND
  Late-onset post-transplantation lymphoproliferative disorders (PTLDs) occur 1 year after transplantation and are associated with poor prognosis. Initial treatment usually involves a reduction in immunosuppressive treatment. While early-onset PTLDs have a good prognosis following RI, this approach is generally inadequate for late-onset PTLDs. We assessed the specific outcome of late-onset PTLDs after kidney transplantation during the past three decades.
  
  
  METHODS
  We reviewed the clinical and biological data of 52 kidney transplant recipients who developed late-onset PTLDs at our centre between 1980 and 2010. We compared clinical features, long-term outcome and renal prognosis of late-onset PTLDs both before and after the era of rituximab.
  
  
  RESULTS
  Before 2000, 38% of the patients underwent surgery and 76% received chemotherapy either immediately or after surgery. After 2000, rituximab was administrated to 70% of the patients either alone (23%) or in combination with chemotherapy (77%). Chemotherapy alone was administrated in 26% of the cases. Before and after 2000, complete remission was achieved in 38 and 87% of the cases, respectively (P = 0.0005). The 5-year overall survival (OS) was 33.3 and 69% (P = 0.003), and 5-year disease-free survival was 37.5 and 80%, respectively (P = 0.19). Renal function was preserved in 70% of the cases at the end of the follow-up.
  
  
  CONCLUSIONS
  This study shows an increase in OS and low graft loss for patients with late-onset PTLDs during the last decade, which may be attributed to multiple changes in clinical practice, including a more standardized treatment and the use of rituximab in combination with chemotherapy.
authors.affiliation: Service de Transplantation Rénale Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Michonneau
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lambert
authors.forename: Julien
authors.initials: J
authors.lastname: Adam
authors.forename: Nicole
authors.initials: N
authors.lastname: Brousse
authors.forename: Danielle
authors.initials: D
authors.lastname: Canioni
authors.forename: Dany
authors.initials: D
authors.lastname: Anglicheau
authors.forename: Frank
authors.initials: F
authors.lastname: Martinez
authors.forename: Renaud
authors.initials: R
authors.lastname: Snanoudj
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Olivier
authors.initials: O
authors.lastname: Hermine
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Mamzer-Bruneel
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D013997:Time Factors
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab