Contributions
Abstract: PB1723
Type: Publication Only
Background
Solid organ transplant recipients have elevated onset risks of hematological malignancies (HMs) due to long-term administration of immunosuppressant. However, few studies about the incidence and impact on survival of HMs following solid organ transplantation have been conducted in Asian countries.
Aims
The aim of this study was to identify the incidence, characteristics, risk factors and prognosis of HMs in solid organ transplant recipients at our institution.
Methods
Clinical data of patients undergoing kidney, liver and heart transplantation in Hokkaido University hospital between 1965 and 2015 were reviewed retrospectively. Kaplan-Meier analysis was performed for the cumulative incidence rates (CI) of HMs, graft survival and patient survival. Patient’s characteristics were compared between groups by the student t-test or Kai-square test.
Results
A total of 16 cases of HMs were identified, 9 post-transplant lymphoproliferative disorder (PTLD), 5 acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), 1 myeloproliferative neoplasm (MPN)) and 1 recurrent non-Hodgkin lymphoma. The CI of PTLD were 1.1%, 1.5% at 5, 10 years in kidney transplant recipients (n=352), 0.92%, 2.6% at 5, 10 years in liver transplant recipients (n=287) and 20% at 1 year heart transplant recipients (n=5), respectively (P<0.0001). AML/MDS and MPN developed only in liver transplant recipients, and CI were 2.3% at 5 and 10 years (P<0.01). There was no difference in background factors other than transplanted organ type between recipients with HMs and without HMs. Patients with EBV-positive PTLD (n=5) were younger (P<0.05) and had less extranodal diseases (P<0.05) compared with EBV-negative PTLD (n=4). All patients with monomorphic PTLD (n= 4) were treated with chemotherapy combined with rituximab and had been in remission. In patients with other PTLD, reduction or withdrawal of immunosuppressant or rituximab alone resulted in stable disease or remission. All AML/MDS but 2 acute promyelocytic leukemia in pediatric patients were chemo-refractory and lethal. 10-year OS were 92% and 100% in kidney and heart transplant recipients. In liver transplant recipients, 10-year OS were 74%, 100% and 50% in patients without disease, with PTLD and with myeloid neoplasm, respectively. Survival in adult liver transplant recipients with myeloid neoplasms was inferior to that without disease (P<0.05). 10-year graft survival rates were 72% and 75% in kidney transplant recipients without disease and with PTLD.
Conclusion
The incidence of PTLD in solid organ transplant recipients in Japan is comparable to that in Western countries, whereas the incidence of myeloid neoplasms is higher in liver transplant recipients. PTLD dose not have a negative impact on the prognosis of solid organ transplant recipients under appropriate management, while heightened awareness and better clinical approach for myeloid neoplasms following solid organ transplantation are needed.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Post-transplant lymphoproliferative disorder, Organ transplant, Myeloid malignancies
Abstract: PB1723
Type: Publication Only
Background
Solid organ transplant recipients have elevated onset risks of hematological malignancies (HMs) due to long-term administration of immunosuppressant. However, few studies about the incidence and impact on survival of HMs following solid organ transplantation have been conducted in Asian countries.
Aims
The aim of this study was to identify the incidence, characteristics, risk factors and prognosis of HMs in solid organ transplant recipients at our institution.
Methods
Clinical data of patients undergoing kidney, liver and heart transplantation in Hokkaido University hospital between 1965 and 2015 were reviewed retrospectively. Kaplan-Meier analysis was performed for the cumulative incidence rates (CI) of HMs, graft survival and patient survival. Patient’s characteristics were compared between groups by the student t-test or Kai-square test.
Results
A total of 16 cases of HMs were identified, 9 post-transplant lymphoproliferative disorder (PTLD), 5 acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), 1 myeloproliferative neoplasm (MPN)) and 1 recurrent non-Hodgkin lymphoma. The CI of PTLD were 1.1%, 1.5% at 5, 10 years in kidney transplant recipients (n=352), 0.92%, 2.6% at 5, 10 years in liver transplant recipients (n=287) and 20% at 1 year heart transplant recipients (n=5), respectively (P<0.0001). AML/MDS and MPN developed only in liver transplant recipients, and CI were 2.3% at 5 and 10 years (P<0.01). There was no difference in background factors other than transplanted organ type between recipients with HMs and without HMs. Patients with EBV-positive PTLD (n=5) were younger (P<0.05) and had less extranodal diseases (P<0.05) compared with EBV-negative PTLD (n=4). All patients with monomorphic PTLD (n= 4) were treated with chemotherapy combined with rituximab and had been in remission. In patients with other PTLD, reduction or withdrawal of immunosuppressant or rituximab alone resulted in stable disease or remission. All AML/MDS but 2 acute promyelocytic leukemia in pediatric patients were chemo-refractory and lethal. 10-year OS were 92% and 100% in kidney and heart transplant recipients. In liver transplant recipients, 10-year OS were 74%, 100% and 50% in patients without disease, with PTLD and with myeloid neoplasm, respectively. Survival in adult liver transplant recipients with myeloid neoplasms was inferior to that without disease (P<0.05). 10-year graft survival rates were 72% and 75% in kidney transplant recipients without disease and with PTLD.
Conclusion
The incidence of PTLD in solid organ transplant recipients in Japan is comparable to that in Western countries, whereas the incidence of myeloid neoplasms is higher in liver transplant recipients. PTLD dose not have a negative impact on the prognosis of solid organ transplant recipients under appropriate management, while heightened awareness and better clinical approach for myeloid neoplasms following solid organ transplantation are needed.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Post-transplant lymphoproliferative disorder, Organ transplant, Myeloid malignancies