Abstract 631P
Background
Post-transplant lymphoproliferative disorder is a fatal complication that can occur early after solid organ or hematopoietic stem cell transplantation (HSCT). It represents a spectrum of Epstein Barr virus (EBV)-related clinical diseases, from benign mononucleosis like illness to malignancies like non-Hodgkin's lymphoma. Some of the established risk factors for PTLD are HLA mismatching, T-cell depletion, and the use of anti-lymphocyte antibodies as conditioning or immunosuppression for the treatment of graft-versus-host disease. Here we present a meta-analysis on PTLD treatment outcomes in adult patients post-HSCT.
Methods
Following PRISMA guidelines, we performed a comprehensive literature search cross-referencing the terms “Post-Transplant Lymphoproliferative disease” and “Treatment outcome” using PubMed, Embase, Google Scholar, and International conference abstracts.
Results
We conducted a meta analysis on 418 patients from 8 studies. All the patients were diagnosed with EBV DNAemia +/- PTLD HSCT. Most patients were treated with rituximab monotherapy or combination therapy (n=238, 57%), while others with reduced-intensity chemotherapy (RIC) (n=178, 42.5%), donor lymphocyte infusion (DLI) (n=2, 1%), radiotherapy (n=1, 0.24%) The pooled complete response (CR) was seen in 71.5% pts (I2=89.94%, 95% CI 48.7%-89.9%, n=152), pooled progression of disease (PD) was seen in 26% pts (I2=0%, 95% CI 17.8%-35%, n=29). Pooled mortality recorded in 42.4% pts (I2=83.11%, 95% CI 23.1%-62.9%, n=56). 1-year-OS is recorded to be 47% by Pericet al R: rituximab;COP: Cyclophosphamide+ Vincristine+ prednisone;CTL: cytotoxic lymphocyte; ATG: anti-thymocyte globulin;CTL: cytotoxic lymphocytes. Table: 631P
| Author year | Patients | Treatment | CR | PR | PD | Death | OS |
| Zhu et al 2019 | 27 | R: 25, R COP: 1, R-CTL:1 | 74% | 7.41% | 15% | 48.15%(PTLD=4) | 1 yr OS 46.8% |
| Peric et al 2011 | 175 | RIC w ATG on 175 pts,f/b preemptive R on 17 pts w EBV DNA > 1000 copies/ 110ˆ5 | 39.4% | 4 yrs OS 47% | |||
| Velden et al 2013 | 61 | R: 53, chemo:9, DLI 1, radiotherapy: 1 | R:90% | 16.4% | |||
| Radeski et al 2022 | 35 | R:4, R-CHOP: 14, R-EPOCH: 7, Palliative care:5, others: 5 | R-CHOP: 50%, R-EPOCH:71% | R: 50% R-CHOP: 29% R-EPOCH:71% | R-CHOP: 29% | ||
| Hou et al 2009 | 11 | R +/-multiple agents: 11 | 9% | 18% | 36% | 91% | |
| Patriarca et al 2013 | 39 | RIC-R:39 | RIC-R: 97.4% | 18% | |||
| Fox et al 2013 | 51 | R:46, R-COP:1, DLI:1, RIC: 3 | R: 70% RIC: 67% DLI: 100% | R:30% | R: 24% RIC:33% | ||
| Gao et al 2019 | 19 | R:16, R-CTL:2, R-DLI:1 | 57.9% | 1yr OS 44.9% |
Conclusions
Rituximab-based therapies seem to have a significant outcome in PTLD patients post-HSCT. PTLD has very limited therapeutic options and a high mortality rate warranting further research for better patient outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.