Rosenberg Aaron S, Klein Andreas K, Ruthazer Robin, Evens Andrew M
University of California Davis School of Medicine, Sacramento, California.
Division of Hematology/Oncology, University of California Davis Medical Center, Sacramento, California.
Am J Hematol. 2016 Jun;91(6):560-5. doi: 10.1002/ajh.24346. Epub 2016 Apr 26.
Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL-PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL-SEER). Overall survival (OS) and disease-specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL-PTLD diagnosis was 88 months. When compared with HL-SEER, patients with HL-PTLD were older (median age, 52 vs. 36 years, P = 0.001), more likely male (73% vs. 54%, P < 0.001), Caucasian (81% vs. 70%, P = 0.02), and had extranodal disease (42% vs. 3%, P < 0.001). Five-year OS for patients with HL-PTLD was 57% versus 80% for HL-SEER (P < 0.001); DSS was also inferior (P < 0.001). For patients with HL-PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR = 0.36, P < 0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR = 2.94, P = 0.001 and 2.01, P = 0.04) versus HL-specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR = 1.26/decade P < 0.001 and 1.64/0.1 mg/dL increase P = 0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10-year OS rates of 79%, 53%, and 11%, respectively (P < 0.001). Altogether, HL-PTLD patients have inferior survival when compared with HL-SEER. Furthermore, treatment with HL-specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival. Am. J. Hematol. 91:560-565, 2016. © 2016 Wiley Periodicals, Inc.
移植后淋巴组织增生性疾病相关的霍奇金淋巴瘤（HL-PTLD）是一种罕见的移植后淋巴组织增生性疾病，其预后尚不清楚，HL-PTLD与免疫功能正常的HL之间的差异也未明确界定。对来自移植受者科学注册系统的192例HL-PTLD患者和监测、流行病学与最终结果数据库（SEER）中的13847例HL患者（HL-SEER）的患者特征进行了比较。在精确匹配后比较了总生存期（OS）和疾病特异性生存期（DSS）。此外，采用多变量分析来确定生存的预后标志物以及治疗与生存之间的关联。从移植到HL-PTLD诊断的中位时间为88个月。与HL-SEER相比，HL-PTLD患者年龄更大（中位年龄，52岁对36岁，P = 0.001），男性更常见（73%对54%，P < 0.001），为白种人（81%对70%，P = 0.02），且有结外病变（42%对3%，P < 0.001）。HL-PTLD患者的5年OS率为57%，而HL-SEER为80%（P < 0.001）；DSS也较差（P < 0.001）。对于HL-PTLD患者，使用任何化疗均与死亡风险降低相关（风险比[HR]=0.36，P < 0.001）。此外，未接受化疗或采用非传统HL方案的患者与采用HL特异性化疗方案的患者相比，死亡风险增加（校正后HR[aHR]=2.94，P = 0.001和2.01，P = 0.04）。在多变量分析中，高龄和肌酐升高与较差的OS相关（aHR = 1.26/每十年，P < 0.001和1.64/每增加0.1mg/dL，P = 0.02）。基于这些不良因素数量（0、1、2）的预后评分分别与10年OS率79%、53%和u1%相关（P < 0.001）。总体而言，与HL-SEER相比，HL-PTLD患者的生存率较低。此外，采用HL特异性化疗与OS改善相关，而年龄和肌酐可识别出生存差异明显的患者。《美国血液学杂志》91:560 - 565，2016年。©2016威利期刊公司
