Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab

被引:4
作者
Fujimoto, Ayumi [1 ,2 ]
Hiramoto, Nobuhiro [2 ]
Yamasaki, Satoshi [3 ]
Inamoto, Yoshihiro [4 ]
Ogata, Masao [5 ]
Sugio, Yasuhiro [6 ]
Fukuda, Takahiro [4 ]
Uchida, Naoyuki [7 ]
Ikegame, Kazuhiro [8 ]
Matsuoka, Ken-ichi [9 ]
Shiratori, Souichi [10 ]
Kondo, Tadakazu [11 ]
Miyamoto, Toshihiro [12 ]
Eto, Tetsuya [13 ]
Ichinohe, Tatsuo [14 ]
Kanda, Yoshinobu [15 ]
Atsuta, Yoshiko [16 ,17 ]
Suzuki, Ritsuro [1 ]
机构
[1] Shimane Univ Hosp, Dept Oncol & Hematol, 89-1 En Ya Cho, Izumo, Shimane 6938501, Japan
[2] Kobe City Med Ctr Gen Hosp, Dept Hematol, Kobe, Hyogo, Japan
[3] Natl Hosp Org Kyushu Med Ctr, Dept Hematol & Clin Res Inst, Fukuoka, Japan
[4] Natl Canc Ctr, Dept Hematopoiet Stem Cell Transplantat, Tokyo, Japan
[5] Oita Univ, Dept Hematol, Fac Med, Oita, Japan
[6] Kitakyushu City Hosp Org, Dept Internal Med, Kitakyushu Municipal Med Ctr, Kitakyushu, Fukuoka, Japan
[7] Federat Natl Publ Serv Personnel Mutual Aid Assoc, Dept Hematol, Tokyo, Japan
[8] Hyogo Coll Med, Div Hematol, Dept Internal Med, Nishinomiya, Hyogo, Japan
[9] Okayama Univ Hosp, Dept Hematol & Oncol, Okayama, Japan
[10] Hokkaido Univ Hosp, Dept Hematol, Sapporo, Hokkaido, Japan
[11] Kyoto Univ, Grad Sch Med, Dept Hematol Oncol, Kyoto, Japan
[12] Kyushu Univ Hosp, Hematol Oncol & Cardiovasc Med, Fukuoka, Japan
[13] Hamanomachi Hosp, Dept Hematol, Fukuoka, Japan
[14] Hiroshima Univ, Res Inst Radiat Biol & Med, Dept Hematol & Oncol, Hiroshima, Japan
[15] Jichi Med Univ, Div Hematol, Saitama Med Ctr, Saitama, Japan
[16] Japanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan
[17] Nagoya Univ, Grad Sch Med, Dept Healthcare Adm, Nagoya, Aichi, Japan
关键词
allogeneic stem cell transplantation; malignant lymphoma; posttransplant lymphoproliferative disorder; rituximab; PREEMPTIVE RITUXIMAB; EUROPEAN GROUP; WORKING PARTY; RISK-FACTORS; ALLO-SCT; REACTIVATION; CHILDREN; THERAPY; DISEASE; BLOOD;
D O I
10.1002/hon.2714
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B-cell, T/NK-cell, and T-cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B-cell lymphoma. Thirty-one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post-HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio [HR] = 5.6, 95% confidence interval [CI], 1.48-21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61-12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26-7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post-HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG-), 0.75% (rituximab-, ATG-), 1.25% (rituximab+, ATG+), and 3.53% (rituximab-, ATG+). Regarding lymphoma subtypes, patients with mature B-cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high-risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high-risk patients.
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页码:146 / 152
页数:7
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