Management and Outcomes of Diffuse Large B Cell Lymphoma Post-Transplant Lymphoproliferative Disorder in the PET/CT Era: A Multicentre Study from the Australasian Lymphoma Alliance

• Published in: Blood 2020-11, Vol.136 (Supplement 1), p.36-38
• Main Authors: Boyle, Stephen, Tobin, Joshua W.D., Perram, Jacinta, Hamad, Nada, Barraclough, Allison, Singaraveloo, Lydia, Han, Min-Hi, Blennerhassett, Richard, Nelson, Niles Elizabeth, Johnston, Anna, Talaulikar, Dipti, Karpe, Krishna, Bhattacharyya, Abir, Cheah, Chan Yoon, Subramoniapillai, Elango, Bokhari, Waqas, Lee, Cindy, Hawkes, Eliza A, Gullapalli, Veena, Jabbour, Andrew, Strasser, Simone, Chadban, Steve, Brown, Christina, Mollee, Peter, Hapgood, Greg
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2020-140665

Introduction Post-transplant lymphoproliferative disorders (PTLD) are aggressive lymphomas which occur in solid organ transplant recipients and cause significant mortality. In the era of positron emission tomography (PET) staging and rituximab (R), there is limited real-world data on treatment outcomes and the incidence of graft rejection after reduction in immunosuppression (RIS) has not been well defined. We report real-world outcomes of monomorphic diffuse large B cell lymphoma (DLBCL), the commonest histological subtype of PTLD in which treatment is most likely to be standardised. Methods We conducted a multicentre retrospective study across 11 Australian tertiary referral centres. Inclusion criteria were: (1) age ≥ 18 years with history of solid organ transplant; (2) a diagnosis of monomorphic DLBCL PTLD between January 2004 and December 2017; (3) staging with PET. We examined responses based on treatment: (1) ’R-primary’ was defined as patients receiving initial rituximab monotherapy followed by further rituximab monotherapy for patients in remission or R-CHOP chemotherapy for patients with persistent or progressive disease; (2) ’R-chemotherapy’ was defined as patients who received rituximab-based chemotherapy at diagnosis. Response assessment was defined according to current international lymphoma criteria (complete metabolic remission (CMR) = Deauville score 1-3). We examined the incidence of clinical and biopsy-proven graft rejection during and after PTLD diagnosis (early