title: Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders.
abstract: Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking.
  
  
  
  A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data.
  
  
  
  Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08).
  
  
  
  Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.
authors: Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA. Electronic address: asrosenberg@ucdavis.edu.
authors: Aaron S
authors: AS
authors: Rosenberg
authors: The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA.
authors: Robin
authors: R
authors: Ruthazer
authors: The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA.
authors: Jessica K
authors: JK
authors: Paulus
authors: Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA.
authors: David M
authors: DM
authors: Kent
authors: Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA.
authors: Andrew M
authors: AM
authors: Evens
authors: Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA.
authors: Andreas K
authors: AK
authors: Klein
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D016377:Organ Transplantation / Q000009:adverse effects*; D010954:Plasmacytoma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: Multiple myeloma; Organ transplantation; PTLD; Prognosis; Survival