Failure of rituximab is associated with a poor outcome in diffuse large B cell lymphoma-type post-transplant lymphoproliferative disorder.
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
/ administration & dosage
Cyclophosphamide
/ administration & dosage
Disease-Free Survival
Doxorubicin
/ administration & dosage
Female
Humans
Lymphoma, Large B-Cell, Diffuse
/ drug therapy
Male
Middle Aged
Organ Transplantation
/ adverse effects
Postoperative Complications
/ drug therapy
Prednisone
/ administration & dosage
Retrospective Studies
Rituximab
/ administration & dosage
Survival Rate
Vincristine
/ administration & dosage
lymphomas
organ transplantation
post transplant lymphoproliferative disorder
rituximab
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
12
07
2019
accepted:
23
09
2019
pubmed:
19
2
2020
medline:
24
11
2020
entrez:
19
2
2020
Statut:
ppublish
Résumé
Post-transplant lymphoproliferative disorder (PTLD) may arise after solid organ transplantation, and the most common subtype resembles diffuse large B cell lymphoma (DLBCL). In DLBCL-type PTLD, the anti-CD20 antibody rituximab (R) may be combined with chemotherapy (R-CHOP) or use a strategy (R-primary; similar to the PTLD-1 clinical trial) consisting of induction with four weekly doses of R-alone, without any chemotherapy or sequential R-CHOP follow-up. Here we report on a multicentre retrospective cohort of solid organ transplant patients with DLBCL-type PTLD that were treated with R. In 168 adults, two-year overall survival (OS) was 63·7% [95% CI (confidence interval) 56·6-71·7%]. No difference in OS was observed, whether patients were treated with R-CHOP versus the R-primary strategy. In the 109 patients treated with R-primary, multivariate analysis found that baseline IPI score and the response to R-induction predicted OS. Patients who responded to R-induction had durable remissions without the addition of chemotherapy. Conversely, of the 46 patients who had stable or progressive disease after R-induction (R-failure), those who received R-CHOP had an only marginally improved outcome, with a two-year OS of 45% (23·1-65·3%) vs. no R-CHOP at 32% (14·7-49·8%). In real-world patients, R-failure and high IPI scores predict a poor outcome in DLBCL-type PTLD.
Substances chimiques
R-CHOP protocol
0
Rituximab
4F4X42SYQ6
Vincristine
5J49Q6B70F
Doxorubicin
80168379AG
Cyclophosphamide
8N3DW7272P
Prednisone
VB0R961HZT
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
97-105Subventions
Organisme : Alberta Innovates Health Solutions
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 British Society for Haematology and John Wiley & Sons Ltd.
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