Presented in part at the 14th European Hematology Association Congress, Berlin, Germany, June 2009, and the 51st Annual Meeting of the American Society of Hematology, New Orleans, LA, December 2009.
Reduction of Immunosuppression as Initial Therapy for Posttransplantation Lymphoproliferative Disorder★
Article first published online: 10 JAN 2011
©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 11, Issue 2, pages 336–347, February 2011
How to Cite
Reshef, R., Vardhanabhuti, S., Luskin, M. R., Heitjan, D. F., Hadjiliadis, D., Goral, S., Krok, K. L., Goldberg, L. R., Porter, D. L., Stadtmauer, E. A. and Tsai, D. E. (2011), Reduction of Immunosuppression as Initial Therapy for Posttransplantation Lymphoproliferative Disorder. American Journal of Transplantation, 11: 336–347. doi: 10.1111/j.1600-6143.2010.03387.x
- Issue published online: 27 JAN 2011
- Article first published online: 10 JAN 2011
- Received 12 June 2010, revised 08 November 2010 and accepted for publication 11 November 2010
- solid organ transplantation
Reduction of immunosuppression (RI) is commonly used to treat posttransplant lymphoproliferative disorder (PTLD) in solid organ transplant recipients. We investigated the efficacy, safety and predictors of response to RI in adult patients with PTLD. Sixty-seven patients were managed with RI alone and 30 patients were treated with surgical excision followed by adjuvant RI. The response rate to RI alone was 45% (complete response—37%, partial response—8%). The relapse rate in complete responders was 17%. Adjuvant RI resulted in a 27% relapse rate. The acute rejection rate following RI-containing strategies was 32% and a second transplant was feasible without relapse of PTLD. The median survival was 44 months in patients treated with RI alone and 9.5 months in patients who remained on full immunosuppression (p = 0.07). Bulky disease, advanced stage and older age predicted lack of response to RI. Survival analysis demonstrated predictors of poor outcome—age, dyspnea, B symptoms, LDH level, hepatitis C, bone marrow and liver involvement. Patients with none or one of these factors had a 3-year overall survival of 100% and 79%, respectively. These findings support the use of RI alone in low-risk PTLD and suggest factors that predict response and survival.