Incidence and outcomes of post-transplant lymphoproliferative disease after 5365 solid-organ transplants over a 20-year period at two UK transplant centres.

in British journal of haematology by Anna Santarsieri, John F Rudge, Irum Amin, Will Gelson, Jasvir Parmar, Stephen Pettit, Lisa Sharkey, Benjamin J Uttenthal, George A Follows

TLDR

  • The study looked at the incidence and outcomes of a serious complication called post-transplant lymphoproliferative disease (PTLD) in people who had received a solid-organ transplant (SOT) over a 20-year period. The study found that the incidence and outcomes of PTLD were different depending on the type of transplant and the treatment received. The study also found that the strongest pretreatment variable associated with inferior one-year OS in monomorphic PTLD patients was an International Prognostic Index (IPI) of 3+. The study suggests that up-front rituximab monotherapy does not compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. The study suggests that future research should focus on finding new treatments for monomorphic PTLD that can improve outcomes for SOT recipients with PTLD. The study also suggests that future research should focus on finding new pretreatment variables that can predict the outcomes of SOT recipients with PTLD.

Abstract

Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of solid-organ transplantation (SOT). We present the incidence and outcomes of PTLD in a cohort of 5365 SOT recipients over a 20-year period at two UK transplant centres. With a median follow-up of 7.7 years, 142 of 5365 patients have developed PTLD. Cumulative incidence was 18% at five years after multivisceral transplant and 1%-3% at five years following the other SOT types. Twenty-year cumulative incidence was 2%-3% following liver and heart transplantation and 10% following kidney transplantation. Median overall survival (OS) following SOT was 16 years, which is significantly reduced compared with the age-adjusted UK population. There is relatively high early mortality following diagnosis of PTLD and only patients surviving two years regained a longer-term survival approaching the non-PTLD SOT cohort. Of 90 patients with monomorphic PTLD, diffuse large B-cell lymphoma, 66 were treated with first-line rituximab monotherapy and 24 received first-line rituximab plus chemotherapy. Up-front rituximab monotherapy does not appear to compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. Multivariate analysis of all 90 monomorphic PTLD patients identified an International Prognostic Index (IPI) of 3+ as the strongest pretreatment variable associating with inferior one-year OS.

Overview

  • The study presents the incidence and outcomes of post-transplant lymphoproliferative disease (PTLD) in a cohort of 5365 solid-organ transplant (SOT) recipients over a 20-year period at two UK transplant centers. The study aims to answer the question of the incidence and outcomes of PTLD in SOT recipients and the effectiveness of different treatments for monomorphic PTLD. The hypothesis being tested is the effectiveness of different treatments for monomorphic PTLD in improving overall survival (OS) for SOT recipients with PTLD. The methodology used for the experiment includes a retrospective cohort study of SOT recipients with PTLD, with a median follow-up of 7.7 years. The study includes demographic information on the SOT recipients, including age, gender, and type of transplant. The study also includes information on the treatment received by the SOT recipients with monomorphic PTLD, including rituximab monotherapy and rituximab plus chemotherapy. The primary objective of the study is to determine the effectiveness of different treatments for monomorphic PTLD in improving OS for SOT recipients with PTLD. The study aims to answer the question of the incidence and outcomes of PTLD in SOT recipients and the effectiveness of different treatments for monomorphic PTLD. The study also aims to identify the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients. The study aims to answer the question of the incidence and outcomes of PTLD in SOT recipients and the effectiveness of different treatments for monomorphic PTLD. The study also aims to identify the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients.

Comparative Analysis & Findings

  • The study compares the outcomes observed under different experimental conditions or interventions detailed in the study. The study identifies significant differences in the incidence and outcomes of PTLD in SOT recipients based on the type of transplant. The study also identifies significant differences in the outcomes of SOT recipients with monomorphic PTLD based on the treatment received. The study finds that up-front rituximab monotherapy does not compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. The study also finds that an International Prognostic Index (IPI) of 3+ is the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients. The study identifies significant differences in the incidence and outcomes of PTLD in SOT recipients based on the type of transplant and the treatment received. The study also identifies the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice. The study highlights the importance of identifying the type of transplant and the treatment received in predicting the incidence and outcomes of PTLD in SOT recipients. The study also highlights the importance of identifying the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients. The study suggests that up-front rituximab monotherapy does not compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. The study also suggests that the International Prognostic Index (IPI) of 3+ is the strongest pretreatment variable associating with inferior one-year OS in monomorphic PTLD patients. The study suggests that future research should focus on identifying new treatments for monomorphic PTLD that can improve OS for SOT recipients with PTLD. The study also suggests that future research should focus on identifying new pretreatment variables that can predict the outcomes of SOT recipients with PTLD. The study suggests that future research should focus on identifying new treatments for monomorphic PTLD that can improve OS for SOT recipients with PTLD. The study also suggests that future research should focus on identifying new pretreatment variables that can predict the outcomes of SOT recipients with PTLD.
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