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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

Abstract

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, Postoperative Complications, Proportional Hazards Models, rituximab, Time Factors, Transplantation, Homologous, Viral Load, Virus Activation, young adult

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