Management and Outcomes of Diffuse Large B-cell Lymphoma Post-transplant Lymphoproliferative Disorder in the Era of PET and Rituximab: A Multicenter Study From the Australasian Lymphoma Alliance
Stephen Boyle,
Joshua W. D. Tobin,
Jacinta Perram,
Nada Hamad,
Veena Gullapalli,
Allison Barraclough,
Lydia Singaraveloo,
Min-Hi Han,
Richard Blennerhassett,
Niles Nelson,
Anna M. Johnston,
Dipti Talaulikar,
Krishna Karpe,
Abir Bhattacharyya,
Chan Yoon Cheah,
Elango Subramoniapillai,
Waqas Bokhari,
Cindy Lee,
Eliza A. Hawkes,
Andrew Jabbour,
Simone I. Strasser,
Steven J. Chadban,
Christina Brown,
Peter Mollee,
Greg Hapgood
Affiliations
Stephen Boyle
1 Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Joshua W. D. Tobin
2 University of Queensland, Brisbane, Queensland, Australia
Jacinta Perram
4 Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Nada Hamad
5 Department of Haematology, St Vincent’s Hospital, Sydney, New South Wales, Australia
Veena Gullapalli
5 Department of Haematology, St Vincent’s Hospital, Sydney, New South Wales, Australia
Allison Barraclough
7 Department of Haematology and Olivia Newton John Cancer Research Institute, The Austin Hospital, Melbourne, Victoria, Australia
Lydia Singaraveloo
8 Royal Adelaide Hospital, Adelaide, South Australia, Australia
Min-Hi Han
9 Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
Richard Blennerhassett
10 Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
Niles Nelson
12 Royal Hobart Hospital, Hobart, Tasmania, Australia
Anna M. Johnston
12 Royal Hobart Hospital, Hobart, Tasmania, Australia
Dipti Talaulikar
14 Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
Krishna Karpe
16 Department of Renal Medicine, Canberra Hospital, Canberra, Australian Capital Territory, Australia
Abir Bhattacharyya
10 Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
Chan Yoon Cheah
9 Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
Elango Subramoniapillai
18 Royal Brisbane Hospital, Brisbane, Queensland, Australia
Waqas Bokhari
18 Royal Brisbane Hospital, Brisbane, Queensland, Australia
Cindy Lee
8 Royal Adelaide Hospital, Adelaide, South Australia, Australia
Eliza A. Hawkes
7 Department of Haematology and Olivia Newton John Cancer Research Institute, The Austin Hospital, Melbourne, Victoria, Australia
Andrew Jabbour
21 Department of Cardiology, St Vincent’s Hospital, Sydney, New South Wales, Australia
Simone I. Strasser
11 University of Sydney, Sydney, New South Wales, Australia
Steven J. Chadban
11 University of Sydney, Sydney, New South Wales, Australia
Christina Brown
4 Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Peter Mollee
1 Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Greg Hapgood
1 Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5–14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
