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Low incidence of posttransplant lymphoproliferative disorder after allogeneic stem cell transplantation in patients with lymphoma treated with rituximab
Author(s) -
Fujimoto Ayumi,
Hiramoto Nobuhiro,
Yamasaki Satoshi,
Inamoto Yoshihiro,
Ogata Masao,
Sugio Yasuhiro,
Fukuda Takahiro,
Uchida Naoyuki,
Ikegame Kazuhiro,
Matsuoka Kenichi,
Shiratori Souichi,
Kondo Tadakazu,
Miyamoto Toshihiro,
Eto Tetsuya,
Ichinohe Tatsuo,
Kanda Yoshinobu,
Atsuta Yoshiko,
Suzuki Ritsuro
Publication year - 2020
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2714
Subject(s) - rituximab , medicine , post transplant lymphoproliferative disorder , hematopoietic stem cell transplantation , lymphoma , hazard ratio , gastroenterology , transplantation , lymphoproliferative disorders , diffuse large b cell lymphoma , incidence (geometry) , immunology , confidence interval , oncology , physics , optics
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.