Long-term survival in post-transplant lymphoproliferative disorders with a dose-adjusted ACVBP regimen
Cécile Fohrer, Sophie Caillard, Argyro Koumarianou, Bernard Ellero, Marie-Lorraine Woehl-Jaeglé,
Carole Meyer, Eric Epailly, Marie-Pierre Chenard, Bruno Lioure, Shanti Natarajan-Ame, Frédéric Maloisel, Philippe Lutun, Romain Kessler,
Bruno Moulin, Jean-Pierre Bergerat, Philippe Wolf, Raoul Herbrecht,
Marie-Lorraine Woehl-Jaeglé
General Surgery and Transplantation
Search for more papers by this authorRomain Kessler
Respiratory Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Search for more papers by this authorCécile Fohrer, Sophie Caillard, Argyro Koumarianou, Bernard Ellero, Marie-Lorraine Woehl-Jaeglé,
Carole Meyer, Eric Epailly, Marie-Pierre Chenard, Bruno Lioure, Shanti Natarajan-Ame, Frédéric Maloisel, Philippe Lutun, Romain Kessler,
Bruno Moulin, Jean-Pierre Bergerat, Philippe Wolf, Raoul Herbrecht,
Marie-Lorraine Woehl-Jaeglé
General Surgery and Transplantation
Search for more papers by this authorRomain Kessler
Respiratory Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Search for more papers by this authorCecile Fohrer, Department of Haematology and Oncology, Hôpital de Hautepierre, 67098 Strasbourg, France.E-mail: [email protected]
Summary
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/m2, 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.
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