Decreased survival in hepatitis C patients with monomorphic post-transplant lymphoproliferative disorder after liver transplantation treated with frontline immunochemotherapy

Juan Pablo Alderuccio, Alexandra Stefanovic, Daniel Dammrich, Jennifer Chapman-Fredricks, Francisco Vega, Gennaro Selvaggi, Andreas Tzakis, Izidore Lossos

Research output: Contribution to journalArticle

Abstract

Post-transplant lymphoproliferative disorder (PTLD) develops in 1–3% of liver transplant recipients and no consensus exists about therapeutic management. From 2006 to 2016, 1489 liver transplants were performed at our institution with 20 patients (incidence 1.3%) developing PTLD. Hepatitis C virus (HCV) was the leading cause (n = 10) of liver transplant in PTLD patients. Diffuse large B-cell lymphoma was the most frequent histologic subtype (n = 17), and we report our experience in the management of these patients. Patients were treated with frontline immunochemotherapy without immunosuppression reduction. All evaluable patients achieved a complete remission. Statistically significant decreased survival was identified in HCV-positive patients. Six patients (60%) exhibited increases in HCV RNA levels during therapy. Four patients (40%) developed graft failure and three of them (30%) died from liver dysfunction. This is the first study providing evidence of decreased survival in HCV-positive PTLD patients after liver transplant receiving immunochemotherapy.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalLeukemia and Lymphoma
DOIs
StateAccepted/In press - Dec 19 2017

Fingerprint

Lymphoproliferative Disorders
Hepatitis C
Liver Transplantation
Transplants
Survival
Hepacivirus
Liver
Lymphoma, Large B-Cell, Diffuse
Immunosuppression
Liver Diseases
RNA
Incidence

Keywords

  • hepatitis C virus and immunochemotherapy
  • liver transplant
  • Post-transplant lymphoproliferative disorder

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

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title = "Decreased survival in hepatitis C patients with monomorphic post-transplant lymphoproliferative disorder after liver transplantation treated with frontline immunochemotherapy",
abstract = "Post-transplant lymphoproliferative disorder (PTLD) develops in 1–3{\%} of liver transplant recipients and no consensus exists about therapeutic management. From 2006 to 2016, 1489 liver transplants were performed at our institution with 20 patients (incidence 1.3{\%}) developing PTLD. Hepatitis C virus (HCV) was the leading cause (n = 10) of liver transplant in PTLD patients. Diffuse large B-cell lymphoma was the most frequent histologic subtype (n = 17), and we report our experience in the management of these patients. Patients were treated with frontline immunochemotherapy without immunosuppression reduction. All evaluable patients achieved a complete remission. Statistically significant decreased survival was identified in HCV-positive patients. Six patients (60{\%}) exhibited increases in HCV RNA levels during therapy. Four patients (40{\%}) developed graft failure and three of them (30{\%}) died from liver dysfunction. This is the first study providing evidence of decreased survival in HCV-positive PTLD patients after liver transplant receiving immunochemotherapy.",
keywords = "hepatitis C virus and immunochemotherapy, liver transplant, Post-transplant lymphoproliferative disorder",
author = "Alderuccio, {Juan Pablo} and Alexandra Stefanovic and Daniel Dammrich and Jennifer Chapman-Fredricks and Francisco Vega and Gennaro Selvaggi and Andreas Tzakis and Izidore Lossos",
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AU - Alderuccio, Juan Pablo

AU - Stefanovic, Alexandra

AU - Dammrich, Daniel

AU - Chapman-Fredricks, Jennifer

AU - Vega, Francisco

AU - Selvaggi, Gennaro

AU - Tzakis, Andreas

AU - Lossos, Izidore

PY - 2017/12/19

Y1 - 2017/12/19

N2 - Post-transplant lymphoproliferative disorder (PTLD) develops in 1–3% of liver transplant recipients and no consensus exists about therapeutic management. From 2006 to 2016, 1489 liver transplants were performed at our institution with 20 patients (incidence 1.3%) developing PTLD. Hepatitis C virus (HCV) was the leading cause (n = 10) of liver transplant in PTLD patients. Diffuse large B-cell lymphoma was the most frequent histologic subtype (n = 17), and we report our experience in the management of these patients. Patients were treated with frontline immunochemotherapy without immunosuppression reduction. All evaluable patients achieved a complete remission. Statistically significant decreased survival was identified in HCV-positive patients. Six patients (60%) exhibited increases in HCV RNA levels during therapy. Four patients (40%) developed graft failure and three of them (30%) died from liver dysfunction. This is the first study providing evidence of decreased survival in HCV-positive PTLD patients after liver transplant receiving immunochemotherapy.

AB - Post-transplant lymphoproliferative disorder (PTLD) develops in 1–3% of liver transplant recipients and no consensus exists about therapeutic management. From 2006 to 2016, 1489 liver transplants were performed at our institution with 20 patients (incidence 1.3%) developing PTLD. Hepatitis C virus (HCV) was the leading cause (n = 10) of liver transplant in PTLD patients. Diffuse large B-cell lymphoma was the most frequent histologic subtype (n = 17), and we report our experience in the management of these patients. Patients were treated with frontline immunochemotherapy without immunosuppression reduction. All evaluable patients achieved a complete remission. Statistically significant decreased survival was identified in HCV-positive patients. Six patients (60%) exhibited increases in HCV RNA levels during therapy. Four patients (40%) developed graft failure and three of them (30%) died from liver dysfunction. This is the first study providing evidence of decreased survival in HCV-positive PTLD patients after liver transplant receiving immunochemotherapy.

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