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Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution

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Abstract

The introduction of single-agent rituximab has markedly changed the approach to therapy of patients with post-transplantation lymphoproliferative disorder (PTLD), but response to treatment varies substantially between patients. In the current report, we analyze long-term efficacy of single-agent rituximab in 60 patients and present factors predictive of progression-free and overall survival. Twelve months after completing first-line treatment, 34 of 60 patients (57%) had progressive disease, resulting in a median progression-free survival of 6.0 months at a median follow-up of 16.3 months. Using multivariate Cox regression analysis, the following factors were identified as significantly predictive of overall survival: age at diagnosis, performance status, lactate dehydrogenase (LDH), and time from transplantation to PTLD. Stage of disease and Epstein–Barr virus association of PTLD did not influence overall survival. LDH and time from transplantation to PTLD were also predictive of progression-free survival. The international prognostic index was shown to be of limited predictive value in these patients, but a PTLD-specific prognostic index separated low-, intermediate-, and high-risk patients with high significance: 2-year overall survival rates after first-line treatment with single-agent rituximab were 88, 50, and 0%, respectively. Thus, prognostic indices can be useful tools for prediction of treatment outcome and for the development of risk-adapted treatment strategies in patients with PTLD and may also provide the basis for interstudy comparisons.

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Acknowledgments

All authors are member of the European Study Group on PTLD and gratefully acknowledge the cooperation with the Competence Network Malignant Lymphomas (KML) and the German Study Group on PTLD (DSPTLDSG).

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Authors and Affiliations

  1. Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France

    Sylvain Choquet & Veronique LeBlond

  2. Section Hematology/Oncology, Hoffmann-LaRoche AG, Grenzach-Wyhlen, Germany

    Stephan Oertel

  3. Campus Virchow Klinikum, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charite Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Hanno Riess, Bernd Dörken & Ralf Trappe

  4. Section Hematology/Oncology, Hoffmann-LaRoche AG, Paris, France

    Nathalie Varoqueaux

Authors
  1. Sylvain Choquet
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  2. Stephan Oertel
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  3. Veronique LeBlond
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  4. Hanno Riess
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  5. Nathalie Varoqueaux
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  6. Bernd Dörken
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  7. Ralf Trappe
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Correspondence to Ralf Trappe.

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Sylvain Choquet and Stephan Oertel contributed equally in this paper.

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Choquet, S., Oertel, S., LeBlond, V. et al. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution. Ann Hematol 86, 599–607 (2007). https://doi.org/10.1007/s00277-007-0298-2

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  • DOI: https://doi.org/10.1007/s00277-007-0298-2

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