Summary
RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
Original Article
Management and Outcomes of Diffuse Large B-cell Lymphoma Post-transplant Lymphoproliferative Disorder in the Era of PET and Rituximab: A Multicenter Study From the Australasian Lymphoma Alliance
HemaSphere
Boyle, Stephen; Tobin, Joshua W. D.; Perram, Jacinta; Hamad, Nada; Gullapalli, Veena; Barraclough, Allison; Singaraveloo, Lydia; Han, Min-Hi; Blennerhassett, Richard; Nelson, Niles; Johnston, Anna M.; Talaulikar, Dipti; Karpe, Krishna; Bhattacharyya, Abir; Cheah, Chan Yoon; Subramoniapillai, Elango; Bokhari, Waqas; Lee, Cindy; Hawkes, Eliza A.; Jabbour, Andrew; Strasser, Simone I.; Chadban, Steven J.; Brown, Christina; Mollee, Peter; Hapgood, Greg
Abstract
There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5–14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
Disclosures
AB received conference sponsorship from Roche. DT received honoraria from Roche, Janssen, Takeda, Amgen; she received research funding from Roche, Janssen; and she received advisory boards from Amgen, Janssen and Roche. NH received Honoraria/Speaker’s fees from Abbvie and Novartis. EAH received Honoraria/Speaker’s fees from Roche, Janssen, Takeda, Bristol-Myers Squibb; she received advisory boards from Janssen, Celgene, Merck Sharp Dohme, Roche; she received research funding from Bristol-Myers Squibb, Celgene, Merck Sharp Dohme, Astra Zeneca; and she received travel expenses from Takeda, Roche, Janssen. AJ received honoraria from Janssen; he received advisory boards from Roche, Janssen, Merck Sharp Dohme; and he received travel support from Roche. CYC received Honoraria/Consulting/Advisory board from Roche, Janssen, MSD, Gilead, Ascentage Pharma, Acerta, Loxo Oncology, TG therapeutics; he research funding from Celgene, Roche, Abbvie; and he received travel expenses from Roche. SIS received honoraria or advisory board participation from Gilead Sciences, Bayer Healthcare, Ipsen, Eisai, MSD, Bristol-Myers Squibb, Roche, AbbVie, CSL Behring, Astra Zeneca, Novartis, Astellas. PM received Janssen Membership on an entity’s Board of Directors or advisory committees and Research Funding; he received membership on an entity’s Board of Directors or advisory committees from BMS/Celgene, Amgen, Takeda, Pfizer, Caelum Membership. GH received advisory board from Roche. All the other authors have no conflicts of interest to disclose.