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Identification of Prognostic Factors in 61 Patients With Posttransplantation Lymphoproliferative Disorders

From the Département d’Hématologie, Laboratoire d’hématologie, Laboratoire d’anatomopathologie, Service d’urologie et de transplantation rénale, and Service de Chirurgie Thoracique, Hôpital Pitié-Salpétrière; Service de Néphrologie and Service d’Hématologie, Hôpital Necker; Service d’Hématologie biologique, Hôpital Avicenne, Bobigny; and Département de biostatistiques et informatique médicale, U444 Inserm, Paris, France.

Address reprint requests to Véronique Leblond, MD, Département d’hématologie, Hôpital Pitié-Salpêtrière, 47 boulevard de l’Hôpital, 75013 Paris France; email: veronique.leblond{at}psl.ap-hop-paris.fr

PURPOSE: Prognostic studies of posttransplantation lymphoproliferative disorders (PTLDs) are hindered by the small number of cases at each transplant center. We analyzed prognostic factors and long-term outcome according to clinical manifestations, pathologic features, and treatment and investigated the prognostic value of the non-Hodgkin’s lymphoma International Prognostic Index (IPI) in 61 patients with PTLD.

PATIENTS AND METHODS: We studied 61 patients in two institutions who developed PTLD and analyzed factors influencing the complete remission and survival rates.

RESULTS: In univariate analysis, factors predictive of failure to achieve complete remission were performance status (PS) (P = .0001) and nondetection of Epstein-Barr virus (EBV) in the tumor (P = .01). Only a negative link with PS 2 was observed in multivariate analysis. In univariate analysis, factors predictive of lower survival were PS 2, the number of sites (one v > one), primary CNS localization, T-cell origin, monoclonality, nondetection of EBV, and treatment with chemotherapy. The IPI failed to identify a patient subgroup with better survival and was less predictive of the response rate than was a specific index using two risk factors (PS and number of involved sites), which defined three groups of patients: low-risk patients whose median survival time has not yet been reached, intermediate-risk patients with a median survival time of 34 months, and high-risk patients with a median survival time of 1 month.

CONCLUSION: PS and the number of involved sites defined three risk groups in our population. The value of these prognostic factors needs to be confirmed in larger cohorts of patients treated in prospective multicenter studies.

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