Identification of Prognostic Factors in Post-Transplant Lymphoproliferative Disorders

  • Sylvain Choquet
  • Marie-France Mamzer Bruneel
  • Olivier Hermine
  • Raphaël Porcher
  • Stephanie Nguyen Quoc
  • Frédéric Davi
  • Frédéric Charlotte
  • Richard Dorent
  • Benoit Barrou
  • Jean-Paul Vernant
  • Martine Raphael
  • Vincent Levy
  • Véronique Leblond
Conference paper

DOI: 10.1007/978-3-642-56352-2_9

Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 159)
Cite this paper as:
Choquet S. et al. (2002) Identification of Prognostic Factors in Post-Transplant Lymphoproliferative Disorders. In: Oertel S.H., Riess H. (eds) Immunosurveillance, Immunodeficiencies and Lymphoproliferations. Recent Results in Cancer Research, vol 159. Springer, Berlin, Heidelberg

Abstract

Organ transplantations can lead to post-transplant lymphoproliferative disorders (PT-LPDs) as a result of immunosuppressive therapy. PT-LPDs clearly differ from non-Hodgkin’s lymphomas occurring in immunocompetent patients, in terms of clinical presentation, pathological findings and treatment response. Several studies have tried to establish some prognostic factors but the small number of patients hinders the analysis. We studied 61 patients from two transplant centers who developed a PT-LPD after kidney (34 patients), heart (19 patients), lung (4 patients) or liver (3 patients) transplantation. Treatment consisted of modification of the immunosuppressive regimen, chemotherapy and/or monoclonal antibody infusions. Analyzing potential prognostic factors, we found that factors predictive of failure to achieve a complete remission were, in univariate analysis, a performance status (PS) ≥2 and negativity of the tumor for the Epstein-Barr virus (EBV), and in multivariate analysis, only the PS. Factors predictive of lower survival were, in univariate analysis, a PS >2, number of sites > 1, primary central nervous system (CNS) location, T-cell phenotype, monoclonality of the tumor, tumor negativity for EBV and chemotherapy as a first treatment; in multivariate analysis. only PS and the number of sites were statistically significant. The International Prognostic Index (IPI) failed to identify a patient subgroup with a lower survival or treatment response, whereas a simple index using PS and number of sites clearly identified three different groups. The median survival has not yet been reached in the lowerrisk group, whereas it is 34 months in the intermediate-risk patients and 1 month in the high-risk group. Studies on larger cohorts of patients need to be performed to confirm these data.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2002

Authors and Affiliations

  • Sylvain Choquet
    • 1
  • Marie-France Mamzer Bruneel
    • 2
  • Olivier Hermine
    • 3
  • Raphaël Porcher
    • 4
  • Stephanie Nguyen Quoc
    • 1
  • Frédéric Davi
    • 5
  • Frédéric Charlotte
    • 6
  • Richard Dorent
    • 7
  • Benoit Barrou
    • 8
  • Jean-Paul Vernant
    • 1
  • Martine Raphael
    • 9
  • Vincent Levy
    • 4
  • Véronique Leblond
    • 1
  1. 1.Département d’HématologieHôpital Pitié-SalpétrièreParis Cedex 13France
  2. 2.Service de NéphrologieHôpital NeckerParisFrance
  3. 3.Service d’HématologieHôpital NeckerParisFrance
  4. 4.Département de Biostatistiques et Informatique MédicaleHôpital Saint-LouisParisFrance
  5. 5.Laboratoire d’HématologieHôpital Pitié-SalpétrièreParisFrance
  6. 6.Laboratoire d’AnatomopathologieHôpital Pitié-SalpétrièreParisFrance
  7. 7.Service de Chirurgie ThoraciqueHôpital Pitié, SalpétrièreParisFrance
  8. 8.Service d’Urologie et de Transplantation RénaleHôpital Pitié-SalpétrièreParisFrance
  9. 9.Service d’Hématologie BiologiqueHôpital AvicenneBobignyFrance

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