Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder

R. Reshef, S. Vardhanabhuti, M. R. Luskin, D. F. Heitjan, D. Hadjiliadis, S. Goral, Karen Krok, L. R. Goldberg, D. L. Porter, E. A. Stadtmauer, D. E. Tsai

Research output: Contribution to journalArticle

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Abstract

Reduction of immunosuppression (RI) is commonly used to treat posttransplant lymphoproliferative disorder (PTLD) in solid organ transplant recipients. We investigated the efficacy, safety and predictors of response to RI in adult patients with PTLD. Sixty-seven patients were managed with RI alone and 30 patients were treated with surgical excision followed by adjuvant RI. The response rate to RI alone was 45% (complete response-37%, partial response-8%). The relapse rate in complete responders was 17%. Adjuvant RI resulted in a 27% relapse rate. The acute rejection rate following RI-containing strategies was 32% and a second transplant was feasible without relapse of PTLD. The median survival was 44 months in patients treated with RI alone and 9.5 months in patients who remained on full immunosuppression (p = 0.07). Bulky disease, advanced stage and older age predicted lack of response to RI. Survival analysis demonstrated predictors of poor outcome-age, dyspnea, B symptoms, LDH level, hepatitis C, bone marrow and liver involvement. Patients with none or one of these factors had a 3-year overall survival of 100% and 79%, respectively. These findings support the use of RI alone in low-risk PTLD and suggest factors that predict response and survival.

Original languageEnglish (US)
Pages (from-to)336-347
Number of pages12
JournalAmerican Journal of Transplantation
Volume11
Issue number2
DOIs
StatePublished - Feb 1 2011

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Lymphoproliferative Disorders
Immunosuppression
Therapeutics
Recurrence
Survival
Transplants
Survival Analysis
Hepatitis C
Dyspnea
Bone Marrow
Safety

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Reshef, R., Vardhanabhuti, S., Luskin, M. R., Heitjan, D. F., Hadjiliadis, D., Goral, S., ... Tsai, D. E. (2011). Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder. American Journal of Transplantation, 11(2), 336-347. https://doi.org/10.1111/j.1600-6143.2010.03387.x
Reshef, R. ; Vardhanabhuti, S. ; Luskin, M. R. ; Heitjan, D. F. ; Hadjiliadis, D. ; Goral, S. ; Krok, Karen ; Goldberg, L. R. ; Porter, D. L. ; Stadtmauer, E. A. ; Tsai, D. E. / Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder. In: American Journal of Transplantation. 2011 ; Vol. 11, No. 2. pp. 336-347.
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Reshef, R, Vardhanabhuti, S, Luskin, MR, Heitjan, DF, Hadjiliadis, D, Goral, S, Krok, K, Goldberg, LR, Porter, DL, Stadtmauer, EA & Tsai, DE 2011, 'Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder', American Journal of Transplantation, vol. 11, no. 2, pp. 336-347. https://doi.org/10.1111/j.1600-6143.2010.03387.x

Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder. / Reshef, R.; Vardhanabhuti, S.; Luskin, M. R.; Heitjan, D. F.; Hadjiliadis, D.; Goral, S.; Krok, Karen; Goldberg, L. R.; Porter, D. L.; Stadtmauer, E. A.; Tsai, D. E.

In: American Journal of Transplantation, Vol. 11, No. 2, 01.02.2011, p. 336-347.

Research output: Contribution to journalArticle

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AU - Vardhanabhuti, S.

AU - Luskin, M. R.

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AU - Hadjiliadis, D.

AU - Goral, S.

AU - Krok, Karen

AU - Goldberg, L. R.

AU - Porter, D. L.

AU - Stadtmauer, E. A.

AU - Tsai, D. E.

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