Journal Article

Autologous stem cell transplantation for post-transplant lymphoproliferative disorders after solid organ transplantation: a retrospective analysis from the Lymphoma Working Party of the EBMT

Kerre Tessa, Bachy Emmanuel, Eyre, Toby A, Bargetzi Mario, Tholouli Eleni, Montoto, Silvia, Zimmermann Heiner, Gandhi, Damaj, Hilgendorf Inken, Boumendil Ariane, De Wilde Virginie, Crawley, Charles, Kanfer, Edward, Kozák Tomáš, Caillard Sophie, Kothari Jaimal, Trappe, Ralf Ulrich, Trněný Marek, Broom, Angus, Robinson, Stephen, Finel Herve

2021

Overview

Published data describing the efficacy and safety of autologous stem-cell transplantation (autoSCT) in post-transplant lymphoproliferative disorders (PTLD) is limited to case reports. This is a retrospective analysis of 21 patients reported to the EBMT registry who received an autoSCT for PTLD post solid organ transplant (SOT). Median age at autoSCT was 47 (range: 22–71) years. The commonest SOTs were kidney (48%) and liver (24%). Commonest histologies included DLBCL-type PTLD (14/21) and plasmacytoma-like PTLD (3/21). Patients received a median of two lines of therapy (range: 1–4) pre-autoSCT. ECOG performance status pre-autoSCT was 0 in 14% and 1 in 86%. Remission status pre-autoSCT was CR 47% and PR 38%. BEAM conditioning was used in 57% and high-dose melphalan in 10%. The median follow-up post-autoSCT was 64 months for alive patients. 3-year PFS was 62% [95% confidence interval (CI) 44–87%] and 3-year OS was 61% [95% CI:43–86]. There were 12 deaths, including four related to autoSCT. 100-day non-relapse-mortality (NRM) was 14% and 1-year NRM was 24%. This study suggests that autoSCT, although feasible and with potential therapeutic activity, is associated with a high NRM, primarily driven by infectious toxicity. A multi-disciplinary approach, expert microbiological input and stringent patient selection are required to optimise outcomes.

• Publisher: Nature Publishing Group
• Subject: Autografts / Case reports / Confidence intervals / Disorders / Immunoproliferative diseases / Lymphatic diseases / Lymphocytes / Lymphoma / Melphalan / Plasmacytoma / Posttransplant lymphoproliferative disorders / Remission / Stem cell transplantation / Stem cells / Toxicity / Transplantation / Transplants & implants