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Posttransplant lymphoproliferative disorder in pediatric patients: Survival rates according to primary sites of occurrence and a proposed clinical categorization
Author(s) -
L'Huillier Arnaud G.,
Dipchand Anne I.,
Ng Vicky L.,
Hebert Diane,
Avitzur Yaron,
Solomon Melinda,
Ngan BoYee,
Stephens Derek,
Punnett Angela S.,
Barton Michelle,
Allen Upton D.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15358
Subject(s) - medicine , lymph node , survival analysis , post transplant lymphoproliferative disorder , clinical significance , gastroenterology , lymphoma , rituximab
Posttransplant lymphoproliferative disorder ( PTLD ) is a devastating complication of organ transplant. In a hospital‐based registry, we identified biopsy‐proven cases of PTLD among children during a 15‐year period and reviewed trends in PTLD rates, the sites of involvement, and the associated survival rates. Cases that were included had at least 1 year of follow‐up after the diagnosis of PTLD . We studied 82 patients with first‐episode PTLD . Median age at diagnosis was 6.4 years (IQR 3.2‐12.3 years). The most frequent PTLD sites were tonsillar/adenoidal (T/A [34%]) and gastrointestinal (32%), followed by miscellaneous (defined as less common sites including central nervous system , kidney, lung, and soft tissue [12%]), lymph node (11%), and multisite (11%). Kaplan‐Meier survival curves showed that T/A PTLD was associated with decreased all‐cause mortality compared with PTLD at other sites (log‐rank 0.004), even after adjustment for histological subtype ( P = .047). PTLD ‐related mortality was also decreased among T/A PTLD (log‐rank 0.012) but showed a trend toward significance only after adjustment for histological subtype ( P = .09). Among first episodes of PTLD , T/A PTLD was associated with a survival advantage compared with PTLD at other sites, even after adjustment for potential confounders. Based on our observations, we propose a clinical categorization of PTLD according to anatomical site of occurrence.