1. Real-world Outcomes With Rituximab-based Therapy for Posttransplant Lymphoproliferative Disease Arising After Solid Organ Transplant
- Author
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Josh Wright, Christopher McNamara, Bindu Vydianath, Kate Cwynarski, Robert Hollows, Rod Johnson, Jin-Sup Shin, Anne Lennard, Paul Fields, Katherine Clesham, Christopher P. Fox, David M. Burns, Yan A Hodgson, L. G. Robinson, Lynsey Fredrick, Sridhar Chaganti, Catherine Byrne, Joanna Haughton, Michelle Lannon, and Hayder Hussein
- Subjects
Adult ,Male ,medicine.medical_specialty ,Vincristine ,Time Factors ,Adolescent ,medicine.medical_treatment ,CHOP ,Liver transplantation ,Gastroenterology ,Young Adult ,International Prognostic Index ,Antineoplastic Agents, Immunological ,Risk Factors ,hemic and lymphatic diseases ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Progression-free survival ,Cyclophosphamide ,Aged ,Retrospective Studies ,Aged, 80 and over ,Transplantation ,Chemotherapy ,business.industry ,Organ Transplantation ,Middle Aged ,Lymphoproliferative Disorders ,Progression-Free Survival ,England ,Doxorubicin ,Prednisolone ,Prednisone ,Rituximab ,Female ,business ,medicine.drug - Abstract
Background Optimal upfront therapy for posttransplant lymphoproliferative disease (PTLD) arising after solid organ transplant remains contentious. Rituximab monotherapy (R-Mono) in unselected patients has shown a lack of durable remissions. Cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP)-based chemotherapy confers improved response rates, although concerns exist about toxicity. Methods This multicenter retrospective study reports outcomes for adults with biopsy-proven B-cell PTLD treated initially with R-Mono or Rituximab plus CHOP (R-CHOP). Selection of therapy was made according to physician preference. Results Among 101 patients, 41 received R-Mono and 60 had R-CHOP. Most (93%) had undergone renal or liver transplantation. R-CHOP showed a trend toward improved complete (53% versus 71%; P = 0.066) and overall (75% versus 90%; P = 0.054) response rates. In the R-Mono group, 13 of 41 (32%) subsequently received chemotherapy, while 25 of 41 (61%) remained progression-free without further therapy. With median follow-up of 47 months, overall survival (OS) was similar for R-Mono and R-CHOP, with 3-year OS of 71% and 63%, respectively (P = 0.722). Non-PTLD mortality was 3 of 41 (7%) and 4 of 60 (7%) within 12 months of R-Mono or R-CHOP, respectively. The International Prognostic Index was statistically significant, with low- (0-2 points) and high-risk (≥3 points) groups exhibiting 3-year OS of 78% and 54%, respectively (P = 0.0003). In low-risk PTLD, outcomes were similar between therapies. However, in high-risk disease R-Mono conferred an inferior complete response rate (21% versus 68%; P = 0.006), albeit with no impact on survival. Conclusions Our data support R-Mono as initial therapy for PTLD arising after renal or liver transplantation. However, upfront R-CHOP may benefit selected high-risk cases in whom rapid attainment of response is desirable.
- Published
- 2020