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Primary CNS Posttransplant Lymphoproliferative Disease (PTLD): An International Report of 84 Cases in the Modern Era

Identifieur interne : 004D28 ( Main/Exploration ); précédent : 004D27; suivant : 004D29

Primary CNS Posttransplant Lymphoproliferative Disease (PTLD): An International Report of 84 Cases in the Modern Era

Auteurs : A. M. Evens [États-Unis] ; S. Choquet [France] ; A. R. Kroll-Desrosiers [États-Unis] ; D. Jagadeesh [États-Unis] ; S. M. Smith [États-Unis] ; F. Morschhauser [France] ; V. Leblond [France] ; R. Roy [États-Unis] ; B. Barton [États-Unis] ; L. I. Gordon [États-Unis] ; M. K. Gandhi [Australie] ; D. Dierickx [Belgique] ; D. Schiff [États-Unis] ; T. M. Habermann [États-Unis] ; R. Trappe [Allemagne]

Source :

RBID : Pascal:13-0235169

Descripteurs français

English descriptors

Abstract

We performed a multicenter, International analysis of solid organ transplant (SOT)-related primary central nervous system (PCNS) posttransplant lymphoproliferative disease (PTLD). Among 84 PCNS PTLD patients, median time of SOT-to-PTLD was 54 months, 79% had kidney SOT, histology was monomorphic in 83% and tumor was EBV+ in 94%. Further, 33% had deep brain involvement, 10% had CSF involvement, while none had ocular disease. Immunosuppression was reduced in 93%; additional first-line therapy included high-dose methotrexate (48%), high-dose cytarabine (33%), brain radiation (24%) and/or rituximab (44%). The overall response rate was 60%, while treatment-related mortality was 13%. With 42-month median follow-up, three-year progression-free survival (PFS) and overall survival (OS) were 32% and 43%, respectively. There was a trend on univariable analysis for improved PFS for patients who received rituximab and/or high-dose cytarabine. On multivariable Cox regression, poor performance status predicted inferior PFS (HR 2.61, 95% CI 1.32-5.17, p = 0.006), while increased LDH portended inferior OS (HR 4.16, 95% CI 1.29-13.46, p = 0.02). Moreover, lack of response to first-line therapy was the most dominant prognostic factor on multivariable analysis (HR 8.70, 95% CI 2.56- 29.57, p = 0.0005). Altogether, PCNS PTLD appears to represent a distinct clinicopathologic entity within the PTLD spectrum that is associated with renal SOT, occurs late, is monomorphic and retains EBV positivity.


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Le document en format XML

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<name sortKey="Trappe, R" sort="Trappe, R" uniqKey="Trappe R" first="R." last="Trappe">R. Trappe</name>
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<s1>Department of Hematology and Oncology, University Medical Center Schleswig-Holstein, Campus Kiel</s1>
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<s3>DEU</s3>
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<region type="land" nuts="2">Schleswig-Holstein</region>
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<title level="j" type="main">American journal of transplantation : (Print)</title>
<title level="j" type="abbreviated">Am. j. transplant. : (Print)</title>
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<title level="j" type="main">American journal of transplantation : (Print)</title>
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<term>Antineoplastic agent</term>
<term>Case study</term>
<term>Central nervous system</term>
<term>Immunomodulator</term>
<term>Immunosuppressive agent</term>
<term>Immunotherapy</term>
<term>International</term>
<term>Lymphoid neoplasm</term>
<term>Lymphoma</term>
<term>Lymphoproliferative syndrome</term>
<term>Monoclonal antibody</term>
<term>Posttransplant lymphoproliferative disorder</term>
<term>Primary</term>
<term>Prognosis</term>
<term>Report</term>
<term>Rituximab</term>
<term>Treatment</term>
<term>World</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Syndrome lymphoprolifératif posttransplantation</term>
<term>Primaire</term>
<term>Système nerveux central</term>
<term>Syndrome lymphoprolifératif</term>
<term>International</term>
<term>Monde</term>
<term>Lymphome</term>
<term>Compte rendu</term>
<term>Etude cas</term>
<term>Rituximab</term>
<term>Pronostic</term>
<term>Immunodépresseur</term>
<term>Immunothérapie</term>
<term>Anticorps monoclonal</term>
<term>Anticancéreux</term>
<term>Immunomodulateur</term>
<term>Traitement</term>
<term>Antigène CD20</term>
<term>Hémopathie maligne lymphoïde</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">We performed a multicenter, International analysis of solid organ transplant (SOT)-related primary central nervous system (PCNS) posttransplant lymphoproliferative disease (PTLD). Among 84 PCNS PTLD patients, median time of SOT-to-PTLD was 54 months, 79% had kidney SOT, histology was monomorphic in 83% and tumor was EBV+ in 94%. Further, 33% had deep brain involvement, 10% had CSF involvement, while none had ocular disease. Immunosuppression was reduced in 93%; additional first-line therapy included high-dose methotrexate (48%), high-dose cytarabine (33%), brain radiation (24%) and/or rituximab (44%). The overall response rate was 60%, while treatment-related mortality was 13%. With 42-month median follow-up, three-year progression-free survival (PFS) and overall survival (OS) were 32% and 43%, respectively. There was a trend on univariable analysis for improved PFS for patients who received rituximab and/or high-dose cytarabine. On multivariable Cox regression, poor performance status predicted inferior PFS (HR 2.61, 95% CI 1.32-5.17, p = 0.006), while increased LDH portended inferior OS (HR 4.16, 95% CI 1.29-13.46, p = 0.02). Moreover, lack of response to first-line therapy was the most dominant prognostic factor on multivariable analysis (HR 8.70, 95% CI 2.56- 29.57, p = 0.0005). Altogether, PCNS PTLD appears to represent a distinct clinicopathologic entity within the PTLD spectrum that is associated with renal SOT, occurs late, is monomorphic and retains EBV positivity.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Allemagne</li>
<li>Australie</li>
<li>Belgique</li>
<li>France</li>
<li>États-Unis</li>
</country>
<region>
<li>Massachusetts</li>
<li>Schleswig-Holstein</li>
<li>Île-de-France</li>
</region>
<settlement>
<li>Amherst (Massachusetts)</li>
<li>Kiel</li>
<li>Paris</li>
</settlement>
<orgName>
<li>Université du Massachusetts</li>
</orgName>
</list>
<tree>
<country name="États-Unis">
<noRegion>
<name sortKey="Evens, A M" sort="Evens, A M" uniqKey="Evens A" first="A. M." last="Evens">A. M. Evens</name>
</noRegion>
<name sortKey="Barton, B" sort="Barton, B" uniqKey="Barton B" first="B." last="Barton">B. Barton</name>
<name sortKey="Gordon, L I" sort="Gordon, L I" uniqKey="Gordon L" first="L. I." last="Gordon">L. I. Gordon</name>
<name sortKey="Habermann, T M" sort="Habermann, T M" uniqKey="Habermann T" first="T. M." last="Habermann">T. M. Habermann</name>
<name sortKey="Jagadeesh, D" sort="Jagadeesh, D" uniqKey="Jagadeesh D" first="D." last="Jagadeesh">D. Jagadeesh</name>
<name sortKey="Kroll Desrosiers, A R" sort="Kroll Desrosiers, A R" uniqKey="Kroll Desrosiers A" first="A. R." last="Kroll-Desrosiers">A. R. Kroll-Desrosiers</name>
<name sortKey="Roy, R" sort="Roy, R" uniqKey="Roy R" first="R." last="Roy">R. Roy</name>
<name sortKey="Schiff, D" sort="Schiff, D" uniqKey="Schiff D" first="D." last="Schiff">D. Schiff</name>
<name sortKey="Smith, S M" sort="Smith, S M" uniqKey="Smith S" first="S. M." last="Smith">S. M. Smith</name>
</country>
<country name="France">
<region name="Île-de-France">
<name sortKey="Choquet, S" sort="Choquet, S" uniqKey="Choquet S" first="S." last="Choquet">S. Choquet</name>
</region>
<name sortKey="Leblond, V" sort="Leblond, V" uniqKey="Leblond V" first="V." last="Leblond">V. Leblond</name>
<name sortKey="Morschhauser, F" sort="Morschhauser, F" uniqKey="Morschhauser F" first="F." last="Morschhauser">F. Morschhauser</name>
</country>
<country name="Australie">
<noRegion>
<name sortKey="Gandhi, M K" sort="Gandhi, M K" uniqKey="Gandhi M" first="M. K." last="Gandhi">M. K. Gandhi</name>
</noRegion>
</country>
<country name="Belgique">
<noRegion>
<name sortKey="Dierickx, D" sort="Dierickx, D" uniqKey="Dierickx D" first="D." last="Dierickx">D. Dierickx</name>
</noRegion>
</country>
<country name="Allemagne">
<region name="Schleswig-Holstein">
<name sortKey="Trappe, R" sort="Trappe, R" uniqKey="Trappe R" first="R." last="Trappe">R. Trappe</name>
</region>
</country>
</tree>
</affiliations>
</record>

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