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03 April 2019 : Original article  

Outcome of Rituximab-Based Treatment for Post-Transplant Lymphoproliferative Disorder After Allogeneic Hematopoietic Stem Cell Transplantation: A Single-Center Experience

Cheng-ying Zhu12BCDEFG, Sha-sha Zhao2B, Xiao-kai Wang3BCE, Li Wang4BC, Fei-yan Wang1CD, Shu Fang2EF, Zhan-xiang Liu2B, Li-xun Guan2D, Yu-chen Liu2D, Yi Ding2E, Li-ping Dou2D, Li-li Wang2D, Chun-ji Gao12FG*

DOI: 10.12659/AOT.914101

Ann Transplant 2019; 24:175-184


BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a rare complication following solid organ transplantation and allogeneic hematopoietic stem cell transplantation (Allo-HSCT), which gives rise to high mortality rates.

MATERIAL AND METHODS: This was a single-center retrospective analysis based on 27 patients who were diagnosed with PTLD following Allo-HSCT between January 1, 2007 and June 2018 at the Chinese PLA General Hospital. The purpose of this analysis was to investigate responses and prognostic factors of rituximab-based treatment.

RESULTS: Twenty-seven patients were treated with rituximab. Among them, 20 of 27 patients (74.07%) had a complete response, 2 of 27 patients (7.41%) had a partial response, 5 of 27 patients (18.52%) had no response, and 22 of 27 patients (81.48%) cleared Epstein-Barr virus (EBV) copies. There were no obvious side effects. The 1-year overall survival (OS) estimate was 46.8% (95% CI, 23.1–65.5%). Univariate analysis revealed that lower OS was correlated with Eastern Cooperative Oncology Group (ECOG) score standard (3–4), Epstein-Barr virus (EBV) viral load (≥10⁶ copies/mL), bacteria or fungal infection, and EBV reactivation were positive after treatment with 1 or 2 doses of rituximab (P<0.05). Multivariate analysis showed that each of the following were independently associated with lower OS (P<0.05): female, ECOG score standard (3–4), and EBV reactivation were positive after treatment with 1 or 2 doses of rituximab.

CONCLUSIONS: Our results demonstrated that rituximab-based treatment was a safe and effective strategy for patients who were diagnosed with PTLD following Allo-HSCT. The identified prognostic factors may help to detect which PTLD patients are at a higher risk of mortality.

Keywords: Epstein-Barr Virus Infections, Graft vs Host Disease, Lymphoproliferative Disorders, Transplants, Adolescent, Antineoplastic Agents, Immunological, Child, DNA, Viral, Kaplan-Meier Estimate, Middle Aged, Postoperative Complications, Prognosis, Proportional Hazards Models, Retrospective Studies, rituximab, Time Factors, Transplantation, Homologous, Treatment Outcome, Viral Load, Virus Activation, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358