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Risk of lymphoproliferative disorders after bone marrow transplantation: a multi-institutional study
R E Curtis1, L B Travis, P A Rowlings
1Division of Cancer Epidemiology, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA. curtisr@epndce.nci.nih.gov
Blood
|September 25, 1999
Summary
Posttransplant lymphoproliferative disorders (PTLD) affect 1% of patients within 10 years after allogeneic bone marrow transplantation (BMT). Risk factors include T-cell depletion and graft-versus-host disease (GVHD) prophylaxis, especially with unrelated donors.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Posttransplant lymphoproliferative disorders (PTLD) are a serious complication following allogeneic bone marrow transplantation (BMT).
- Understanding the incidence and risk factors for PTLD is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence of PTLD after allogeneic BMT.
- To identify risk factors associated with early- and late-onset PTLD.
Main Methods:
- A retrospective analysis of 18,014 patients who underwent allogeneic BMT at 235 global centers.
- Multivariate analyses were used to determine risk factors for PTLD.
Main Results:
- The cumulative incidence of PTLD was 1.0% at 10 years post-BMT, with the highest incidence occurring within the first year.
- Early-onset PTLD (<1 year) was strongly associated with unrelated or HLA-mismatched donors, T-cell depletion, and GVHD prophylaxis (antithymocyte globulin, anti-CD3).
- Extensive chronic GVHD was the primary risk factor for late-onset PTLD.
Conclusions:
- Altered immunity and T-cell regulation are key predictors of PTLD development after BMT.
- Specific T-cell depletion methods and GVHD prophylaxis strategies significantly influence PTLD risk.
- Identifying patients with multiple risk factors is essential for PTLD risk stratification.