Rituximab failure may predict a poor outcome among patients with diffuse large B-cell lymphoma (DLBCL)-resembling post-transplant lymphoproliferative disorder (PTLD), according to research published in the British Journal of Haematology.
PTLDs develop in 1% to 9% of all patients who undergo solid organ transplant, of which there are more than 125,000 per year. DLBCL-resembling PTLD, the most common monomorphic post-transplant disorder, presents a difficult clinical scenario because aggressive treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) can be fatal in up to 31% of patients.
Previous research has suggested that rituximab, either alone or with CHOP (R-CHOP), can be effective in this setting without a high incidence of treatment-related mortality. For this multicenter retrospective study, researchers evaluated whether rituximab or R-CHOP yield favorable outcomes in the real world setting among patients with DLBCL-resembling PTLD.
Of 168 patients identified with DLBCL-resembling PTLD, 155 were included in this analysis. Among the 109 patients who received a rituximab-primary strategy, 84 received rituximab only and 25 received rituximab induction followed by CHOP; 46 patients received R-CHOP upfront. Overall, the age at diagnosis was 52.5 years, 67% of patients were male, and 38% of patients were Epstein-Barr virus (EBV)-positive.
The 2-year overall survival (OS) rate in the cohort was 63.7%. The most common cause of death was PTLD progression. However, there were no noted differences in OS between the rituximab-primary and R-CHOP upfront strategies.
Overall, stable disease or progression compared with complete response (hazard ratio [HR], 6.7; P <.001), partial response compared with complete response (HR, 2.8; P =.034), international prognostic index (IPI) high risk compared with low risk (HR, 7.1; P <.001), and male gender (HR, 2.5; P =.004) were predictive of OS. In the rituximab-primary group, end of induction stable disease or disease progression compared with complete response (HR, 3.19; P =.006), IPI high-intermediate risk (HR, 3.88; P =.02) and high risk (HR, 11.2; P <.001) compared with low risk, and male gender (HR, 4.22; P <.001) were each predictive of OS.
EBV status was not found to be predictive of OS.
“[W]e have studied a large retrospective cohort of patients with monomorphic B-cell PTLD resembling DLBCL, and confirm that response to [rituximab] and baseline IPI are key factors in predicting OS,” the researchers concluded. “Moreover, we did not note a difference in OS between R-CHOP and R-sequential-treated patients, although this is subject to the caveats of retrospective data.”
1. Jain MD, Lam R, Liu Z, et al. Failure of rituximab is associated with a poor outcome in diffuse large B cell lymphoma-type post-transplant lymphoproliferative disorder [published online February 18, 2020]. Br J Haematol. doi: 10.1111/bjh.16304