Impact of the Post-Transplant Lymphoproliferative Disorder Subtype on Survival: PTLD Subtype and Survival

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Background: Posttransplant lymphoproliferative disorder (PTLD) is a life‐threatening complication of solid organ transplantation. Histologic heterogeneity and a lack of treatment standards have made evaluating clinical outcomes in specific patient populations difficult. This systematic literature review investigated the impact of the PTLD histologic subtype on survival in a large data set.

Methods: Case series were identified on PubMed with the search terms post‐transplant lymphoproliferative disorder/disease, PTLD, and solid organ transplantation, with additional publications identified through reference lists. The patient characteristics, immunosuppressive regimen, treatment, survival, and follow‐up time for 306 cases were extracted from 94 articles, and these cases were combined with 11 cases from Emory University Hospital. Patients with a recorded subtype were included in a Kaplan‐Meier survival analysis (n = 234). Cox proportional hazards regression analyses identified predictors of overall survival (OS) for each subtype and B‐cell subgroup.

Results: OS differed significantly between monomorphic T‐cell neoplasms (median, 9 months) and polymorphic, monomorphic B‐cell, and Hodgkin‐type neoplasms, for which the median OS was not reached (P = .0001). Significant differences in OS among B subgroups were not detected, but there was a trend toward decreased survival for patients with Burkitt‐type PTLD. Kidney transplantation and a reduction of immunosuppression were associated with increased OS for patients with B‐cell neoplasms in a multivariate analysis. Immunosuppression with azathioprine was associated with decreased OS for patients with T‐cell neoplasms, whereas radiotherapy was associated with improved OS for patients with that subtype.

Conclusions: The histologic subtype represents an important prognostic factor in PTLD, with patients with T‐cell neoplasms exhibiting very poor OS. Possibly lower survival for certain subsets of patients with B‐cell PTLD should be explored further and suggests the need for subtype‐specific therapies to improve outcomes.