title: First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study.
abstract: This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Martínez-Calle
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Alfonso
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: José
authors.initials: J
authors.lastname: Rifón
authors.affiliation: Hepatology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herrero
authors.affiliation: Nephrology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Pedro
authors.initials: P
authors.lastname: Errasti
authors.affiliation: Cardiac Surgery Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Rábago
authors.affiliation: Immunology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Juana
authors.initials: J
authors.lastname: Merino
authors.affiliation: Clinical Department of Pathology, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Panizo
authors.affiliation: Clinical Department of Pathology, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Pardo
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Felipe
authors.initials: F
authors.lastname: Prósper
authors.affiliation: Hematology Department, Hospital San Pedro de Logroño, La Rioja, España.
authors.forename: Ricardo
authors.initials: R
authors.lastname: García-Muñoz
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Ramón
authors.initials: R
authors.lastname: Lecumberri
authors.affiliation: Hematology Department, Clínica Universidad de Navarra, Pamplona, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Panizo
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Aggressive B-NHL; Non-Hodgkin's lymphoma; Post-transplant lymphoproliferative diseases; rituximab; transplantation