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CNS or Bone Marrow Involvement As Risk Factors for Poor Survival in Post-Transplantation Lymphoproliferative Disorders in Children After Solid Organ Transplantation

Britta Maecker, Thomas Jack, Martin Zimmermann, Hashim Abdul-Khaliq, Martin Burdelski, Alexandra Fuchs, Peter Hoyer, Sabine Koepf, Ulrike Kraemer, Guido F. Laube, Dirk E. Müller-Wiefel, Heinrich Netz, Martin Pohl, Burkhard Toenshoff, Hans-Joachim Wagner, Michael Wallot, Karl Welte, Michael Melter, Gisela Offner, Christoph Klein

From the Departments of Pediatric Hematology/Oncology, Pediatric Cardiology, and Pediatric Nephrology, Hannover Medical School, Hannover; Department of Pediatric Cardiology, Deutsches Herzzentrum; Department of Pediatric Nephrology, University Hospital Charité Berlin, Berlin; Departments of Pediatric Gastroenterology and Pediatric Nephrology, University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf; Department of Pediatric Cardiology, University Hospital Grosshadern, Grosshadern; Department of Pediatric Gastroenterology, Dr-von-Haunersches Kinderspital, Munich; Departments of Pediatric Nephrology and Pediatric Hematology/Oncology, Olgahospital Stuttgart, Stuttgart; Department of Pediatrics, Division of Pediatric Nephrology, University Hospital Cologne, Cologne; Department of Pediatrics and Pediatric Neurology, University Hospital Essen, Essen; Division of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg; Departments of Pediatric Cardiology and Pediatric Hematology/Oncology, University Hospital Giessen, Giessen; Department of Pediatric Nephrology, University Hospital Freiburg, Freiburg, Germany; and Department of Pediatric Nephrology, University Hospital Zurich, Zurich, Switzerland

Address reprint requests to Britta Maecker, MD, Pediatric Hematology/Oncology, Medizinische Hochschule Hannover, Carl-Neuberg-Str 1, D-30625 Hannover, Germany; e-mail: maecker.britta{at}mh-hannover.de

Purpose To identify prognostic factors of survival in pediatric post-transplantation lymphoproliferative disorder (PTLD) after solid organ transplantation.

Patients and Methods A multicenter, retrospective case analysis of 55 pediatric solid organ graft recipients (kidney, liver, heart/lung) developing PTLD were reported to the German Pediatric-PTLD registry. Patient charts were analyzed for tumor characteristics (histology, immunophenotypes, cytogenetics, Epstein-Barr virus [EBV] detection), stage, treatment, and outcome. Probability of overall and event-free survival was analyzed in defined subgroups using univariate and Cox regression analyses.

Results PTLD was diagnosed at a median time of 29 months after organ transplantation, with a significantly shorter lag time in liver (0.83 years) versus heart or renal graft recipients (3.33 and 3.10 years, respectively; P = .001). The 5-year overall and event-free survival was 68% and 59%, respectively, with 59% of patients surviving 10 years. Stage IV disease with bone marrow and/or CNS involvement was associated independently with poor survival (P = .0005). No differences in outcome were observed between early- and late-onset PTLD, monomorphic or polymorphic PTLD, and EBV-positive or EBV-negative PTLD, respectively. Patients with Burkitt or Burkitt-like PTLD and c-myc translocations had short survival (< 1 year).

Conclusion Stage IV disease is an independent risk factor for poor survival in pediatric PTLD patients. Prospective multicenter trials are needed to delineate additional risk factors and to assess treatment approaches for pediatric PTLD.

Supported by research funding from the C.D. Foundation and Novartis.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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