Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab |
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| Authors: | Ayumi Fujimoto Nobuhiro Hiramoto Satoshi Yamasaki Yoshihiro Inamoto Masao Ogata Yasuhiro Sugio Takahiro Fukuda Naoyuki Uchida Kazuhiro Ikegame Ken-ichi Matsuoka Souichi Shiratori Tadakazu Kondo Toshihiro Miyamoto Tetsuya Eto Tatsuo Ichinohe Yoshinobu Kanda Yoshiko Atsuta Ritsuro Suzuki Complication Working Group of the Japan Society for Hematopoietic Cell Transplantation |
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| Institution: | 1. Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan;2. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan;3. Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan;4. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan;5. Department of Hematology, Oita University Faculty of Medicine, Oita, Japan;6. Department of Internal Medicine, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan;7. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan;8. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan;9. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan;10. Department of Hematology, Hokkaido University Hospital, Sapporo, Japan;11. Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;12. Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan;13. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan;14. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan;15. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan;16. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan |
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| Abstract: | Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B-cell, T/NK-cell, and T-cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B-cell lymphoma. Thirty-one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post-HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio HR] = 5.6, 95% confidence interval CI], 1.48-21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61-12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26-7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post-HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG?), 0.75% (rituximab?, ATG?), 1.25% (rituximab+, ATG+), and 3.53% (rituximab?, ATG+). Regarding lymphoma subtypes, patients with mature B-cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high-risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high-risk patients. |
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| Keywords: | allogeneic stem cell transplantation malignant lymphoma posttransplant lymphoproliferative disorder rituximab |
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