Clinical Characteristics of Posttransplant Lymphoproliferative Disorder After Cord Blood Transplantation Without Antithymocyte Globulin

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 22; no. 7; pp. 495 - 503
• Main Authors: Sumi, Masahiko, Satomi, Hidetoshi, Kitahara, Mari, Kazumoto, Hiroko, Shishido, Tsutomu, Kaiume, Hiroko, Sato, Keijiro, Ueki, Toshimitsu, Hiroshima, Yuki, Ito, Ichiro, Kobayashi, Hikaru
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: Epstein–Barr virus; Graft-versus-host disease; mycophenolate mofetil; Posttransplant lymphoproliferative disorder; Rituximab; DLBCL; haplo-SCT; GVHD; PTCL-NOS; CBT; Posttransplant lymphoproliferative disorder; allo-SCT; EBV; PTLD; TBI; HSCT; Epstein–Barr virus; Graft-versus-host disease; IM; EBMT; OS; CI; MMF; Rituximab; PSL; EBER; RIC; MAC; CsA; ATG; CuI; Tac; SOT; mycophenolate mofetil; PCR; MALT
• ISSN: 2152-2650; 2152-2669; 2152-2669
• DOI: 10.1016/j.clml.2021.12.015

CBT with ATG use is a well-known PTLD risk factor. However, little is known regarding the clinical features of PTLD after ATG-free CBT. We analyzed the incidence, risk factors and prognosis of PTLD in 183 adults undergoing ATG-free CBT. Fifteen patients (diffuse large B-cell lymphoma, n = 9, mucosa-associated lymphoid tissue lymphoma, n = 2 nondestructive PTLD, n = 1, T-cell lymphoma, n = 3) developed PTLD. The 2-year CuI of PTLD was 8.0% (95% CI: 4.6-12.7). Pathologically, all 12 B-cell PTLD patients had Epstein–Barr virus (EBV), compared with 1 of 3 T-cell PTLD patients. All patients, excluding one with nondestructive PTLD, showed extranodal involvement. In the univariate analysis, the 2-year CuI of PTLD was significantly higher in patients who received mycophenolate mofetil to prevent graft-versus-host disease than in nonrecipients (11.2%/2.9%, P = .0457). However, multivariate analysis revealed no independent PTLD risk factors. All 11 PTLD patients who received specific therapy achieved complete remission. The 1-year overall survival of PTLD patients was 70.9%. Although we found a higher CuI of PTLD than previously reported, the prognosis was generally good. In CBT recipients, many factors, including MMF use, may be associated with the clinical features of PTLD. We retrospectively analyzed 183 patients who underwent cord blood transplantation (CBT) without antithymocyte globulin (ATG) to ascertain the incidence and clinical characteristics of posttransplant lymphoproliferative disorder (PTLD). A higher cumulative incidence (CuI) and better prognosis were observed herein than in previous reports. However, further studies are warranted to clarify the clinical features of PTLD.