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Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation. Blood 2009 May 14;113(20):4992-5001 PMID: 19264919 PMCID: PMC2686146

Pubmed ID

19264919

DOI

10.1182/blood-2008-09-178046

Abstract

We evaluated 26 901 patients who underwent allogeneic hematopoietic cell transplantation (HCT) at 271 centers worldwide to define patterns of posttransplantation lymphoproliferative disorders (PTLDs). PTLDs developed in 127 recipients, with 105 (83%) cases occurring within 1 year after transplantation. In multivariate analyses, we confirmed that PTLD risks were strongly associated (P < .001) with T-cell depletion of the donor marrow, antithymocyte globulin (ATG) use, and unrelated or HLA-mismatched grafts (URD/HLA mismatch). Significant associations were also confirmed for acute and chronic graft-versus-host disease. The increased risk associated with URD/HLA-mismatched donors (RR = 3.8) was limited to patients with T-cell depletion or ATG use (P = .004). New findings were elevated risks for age 50 years or older at transplantation (RR = 5.1; P < .001) and second transplantation (RR = 3.5; P < .001). Lower risks were found for T-cell depletion methods that remove both T and B cells (alemtuzumab and elutriation, RR = 3.1; P = .025) compared with other methods (RR = 9.4; P = .005 for difference). The cumulative incidence of PTLDs was low (0.2%) among 21 686 patients with no major risk factors, but increased to 1.1%, 3.6%, and 8.1% with 1, 2, and more than 3 major risk factors, respectively. Our findings identify subgroups of patients who underwent allogeneic HCT at elevated risk of PTLDs for whom prospective monitoring of Epstein-Barr virus activation and early treatment intervention may be particularly beneficial.

Author List

Landgren O, Gilbert ES, Rizzo JD, SociƩ G, Banks PM, Sobocinski KA, Horowitz MM, Jaffe ES, Kingma DW, Travis LB, Flowers ME, Martin PJ, Deeg HJ, Curtis RE

Authors

Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
J. Douglas D. Rizzo MD, MS Director, Ctr Associate Director, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-66549099010   220 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Case-Control Studies
Child
Child, Preschool
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Infant
Lymphoproliferative Disorders
Male
Middle Aged
Retrospective Studies
Risk Factors
Transplantation, Homologous
Young Adult
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70