research paper: Long-term survival in post-transplant lymphoproliferative disorders with a dose-adjusted ACVBP regimen

• Published in: British journal of haematology 2006-09, Vol.134 (6), p.602-612
• Main Authors: Fohrer, Cecile, Caillard, Sophie, Koumarianou, Argyro, Ellero, Bernard, Woehl-Jaegle, Marie-Lorraine, Meyer, Carole, Epailly, Eric, Chenard, Marie-Pierre, Lioure, Bruno, Natarajan-Ame, Shanti, Maloisel, Frederic, Lutun, Philippe, Kessler, Romain, Moulin, Bruno, Bergerat, Jean-Pierre, Wolf, Philippe, Herbrecht, Raoul
• Format: Article
• Language: English
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/j.1365-2141.2006.06228.x

Post-transplant lymphoproliferative disorders (PTLD) are severe complications after solid organ transplantation with no consensus on best treatment practice. Chemotherapy is a therapeutic option with a high response and a significant relapse rate leading to a low long-term tolerance rate. Currently, most centres use anthracycline-based drug combinations, such as CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). We assessed the efficacy and safety of a dose-adjusted ACVBP (doxorubicin reduced to 50 mg/m super(2), cyclophosphamide adjusted to renal function, vindesine, bleomycin, prednisone) regimen in patients failing to respond to a reduction in immunosuppressive therapy. Favourable responses were observed in 24 (73%) of the 33 treated patients. Fourteen (42%) patients died, mostly from PTLD progression. Actuarial survival was 60% at 5 years and 55% at 10 years. Survival prognostic factors were: number of involved sites (P = 0.007), clinical stage III/IV (P = 0.004), bulky tumour (P < 0.0001), B symptoms (P = 0.03), decreased serum albumin (P = 0.03) and poor performance status (P = 0.06). Both the international and the PTLD prognostic index were predictive for survival (P = 0.001 and P = 0.002, respectively). Overall 128 cycles were given. Grade 3 or 4 neutropenia was recorded after 26 (20%) chemotherapy cycles in 19 (58%) patients. Forty-one (32%) infections were recorded in 26 (79%) patients. This study demonstrated that an individual dose-adjustment of ACVBP regimen was manageable in PTLD patients and favourably impacted on long-term survival.