Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation
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 transplantati...
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| creator | Landgren, Ola Gilbert, Ethel S. Rizzo, J. Douglas Socié, Gérard Banks, Peter M. Sobocinski, Kathleen A. Horowitz, Mary M. Jaffe, Elaine S. Kingma, Douglas W. Travis, Lois B. Flowers, Mary E. Martin, Paul J. Deeg, H. Joachim Curtis, Rochelle E. |
| description | 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. |
| doi_str_mv | 10.1182/blood-2008-09-178046 |
| format | Article |
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Douglas ; Socié, Gérard ; Banks, Peter M. ; Sobocinski, Kathleen A. ; Horowitz, Mary M. ; Jaffe, Elaine S. ; Kingma, Douglas W. ; Travis, Lois B. ; Flowers, Mary E. ; Martin, Paul J. ; Deeg, H. Joachim ; Curtis, Rochelle E.</creator><creatorcontrib>Landgren, Ola ; Gilbert, Ethel S. ; Rizzo, J. Douglas ; Socié, Gérard ; Banks, Peter M. ; Sobocinski, Kathleen A. ; Horowitz, Mary M. ; Jaffe, Elaine S. ; Kingma, Douglas W. ; Travis, Lois B. ; Flowers, Mary E. ; Martin, Paul J. ; Deeg, H. Joachim ; Curtis, Rochelle E.</creatorcontrib><description>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.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood-2008-09-178046</identifier><identifier>PMID: 19264919</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Graft vs Host Disease - etiology ; Hematologic and hematopoietic diseases ; Hematopoietic Stem Cell Transplantation - adverse effects ; Humans ; Infant ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphoproliferative Disorders - etiology ; Male ; Medical sciences ; Middle Aged ; Retrospective Studies ; Risk Factors ; Transplantation ; Transplantation, Homologous ; Young Adult</subject><ispartof>BLOOD, 2009-05, Vol.113 (20), p.4992-5001</ispartof><rights>2009 American Society of Hematology</rights><rights>2009 INIST-CNRS</rights><rights>2009 by The American Society of Hematology 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-b806266362cf304217ea7c87ae2ee3b0f1aa8623a320ce9d5c7e55a29de273323</citedby><cites>FETCH-LOGICAL-c595t-b806266362cf304217ea7c87ae2ee3b0f1aa8623a320ce9d5c7e55a29de273323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,550,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21501388$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19264919$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:118780415$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Landgren, Ola</creatorcontrib><creatorcontrib>Gilbert, Ethel S.</creatorcontrib><creatorcontrib>Rizzo, J. Douglas</creatorcontrib><creatorcontrib>Socié, Gérard</creatorcontrib><creatorcontrib>Banks, Peter M.</creatorcontrib><creatorcontrib>Sobocinski, Kathleen A.</creatorcontrib><creatorcontrib>Horowitz, Mary M.</creatorcontrib><creatorcontrib>Jaffe, Elaine S.</creatorcontrib><creatorcontrib>Kingma, Douglas W.</creatorcontrib><creatorcontrib>Travis, Lois B.</creatorcontrib><creatorcontrib>Flowers, Mary E.</creatorcontrib><creatorcontrib>Martin, Paul J.</creatorcontrib><creatorcontrib>Deeg, H. Joachim</creatorcontrib><creatorcontrib>Curtis, Rochelle E.</creatorcontrib><title>Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation</title><title>BLOOD</title><addtitle>Blood</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Graft vs Host Disease - etiology</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Humans</subject><subject>Infant</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphoproliferative Disorders - etiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Transplantation</subject><subject>Transplantation, Homologous</subject><subject>Young Adult</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp9kU1v1DAQhi0EokvhHyCUC9wC_ogd-4KEqvIhVUJCcLYmzqRr6o2D7V3Uf4-XjVp64WR75nlnxvMS8pLRt4xp_m4IMY4tp1S31LSs17RTj8iGSV4DlNPHZEMpVW1nenZGnuX8k1LWCS6fkjNmuOoMMxsyfPP5ppnAlZhyM8XUhNvdso1LisFPmKD4AzajzzGNWAmYCqYGQojXOKN3zRZ3UOISPZb6chhCUxLMeQkwl6qO83PyZIKQ8cV6npMfHy-_X3xur75--nLx4ap10sjSDpoqrpRQ3E2Cdpz1CL3TPSBHFAOdGIBWXIDg1KEZpetRSuBmRN4LwcU5aU91829c9oNdkt9BurURvF1DN_WGVkojGKv8-xNfMzscHc518PBA9jAz-629jgfLlVasU7XAm7VAir_2mIvd-XzcAMwY99mqnkuldVfB7gS6FHNOON01YdQezbR_zbRHMy019mRmlb36d8B70epeBV6vAGQHYap7dz7fcZxJyoTW9z_Fuv6Dx2Sz8zg7HH1CV-wY_f8n-QPbrsIu</recordid><startdate>20090514</startdate><enddate>20090514</enddate><creator>Landgren, Ola</creator><creator>Gilbert, Ethel S.</creator><creator>Rizzo, J. 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Myelofibrosis</topic><topic>Lymphoproliferative Disorders - etiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Transplantation</topic><topic>Transplantation, Homologous</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Landgren, Ola</creatorcontrib><creatorcontrib>Gilbert, Ethel S.</creatorcontrib><creatorcontrib>Rizzo, J. Douglas</creatorcontrib><creatorcontrib>Socié, Gérard</creatorcontrib><creatorcontrib>Banks, Peter M.</creatorcontrib><creatorcontrib>Sobocinski, Kathleen A.</creatorcontrib><creatorcontrib>Horowitz, Mary M.</creatorcontrib><creatorcontrib>Jaffe, Elaine S.</creatorcontrib><creatorcontrib>Kingma, Douglas W.</creatorcontrib><creatorcontrib>Travis, Lois B.</creatorcontrib><creatorcontrib>Flowers, Mary E.</creatorcontrib><creatorcontrib>Martin, Paul J.</creatorcontrib><creatorcontrib>Deeg, H. 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Douglas</au><au>Socié, Gérard</au><au>Banks, Peter M.</au><au>Sobocinski, Kathleen A.</au><au>Horowitz, Mary M.</au><au>Jaffe, Elaine S.</au><au>Kingma, Douglas W.</au><au>Travis, Lois B.</au><au>Flowers, Mary E.</au><au>Martin, Paul J.</au><au>Deeg, H. Joachim</au><au>Curtis, Rochelle E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation</atitle><jtitle>BLOOD</jtitle><addtitle>Blood</addtitle><date>2009-05-14</date><risdate>2009</risdate><volume>113</volume><issue>20</issue><spage>4992</spage><epage>5001</epage><pages>4992-5001</pages><issn>0006-4971</issn><eissn>1528-0020</eissn><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.</abstract><cop>Washington, DC</cop><pub>Elsevier Inc</pub><pmid>19264919</pmid><doi>10.1182/blood-2008-09-178046</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Biological and medical sciences Case-Control Studies Child Child, Preschool Female Graft vs Host Disease - etiology Hematologic and hematopoietic diseases Hematopoietic Stem Cell Transplantation - adverse effects Humans Infant Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphoproliferative Disorders - etiology Male Medical sciences Middle Aged Retrospective Studies Risk Factors Transplantation Transplantation, Homologous Young Adult |
| title | Risk factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation |
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