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A population-based ...
A population-based study of 135 lymphomas after solid organ transplantation : The role of Epstein-Barr virus, hepatitis C and diffuse large B-cell lymphoma subtype in clinical presentation and survival.
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- Kinch, Amelie (author)
- Uppsala universitet,Infektionssjukdomar
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- Baecklund, Eva (author)
- Uppsala universitet,Reumatologi
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- Backlin, Carin (author)
- Uppsala universitet,Reumatologi
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Ekman, Tor (author)
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- Molin, Daniel (author)
- Uppsala universitet,Enheten för onkologi
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- Tufveson, Gunnar (author)
- Uppsala universitet,Transplantationskirurgi
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Fernberg, Pia (author)
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- Sundström, Christer (author)
- Uppsala universitet,Institutionen för immunologi, genetik och patologi
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- Pauksens, Karlis (author)
- Uppsala universitet,Infektionssjukdomar
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- Enblad, Gunilla (author)
- Uppsala universitet,Enheten för onkologi
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(creator_code:org_t)
- 2014
- 2014
- English.
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In: Acta Oncologica. - 0284-186X .- 1651-226X. ; 53:5, s. 669-679
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.3...
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Abstract
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- Background. Epstein-Barr virus (EBV) plays a major role in the development of post-transplant lymphoproliferative disorder (PTLD), but there is an increasing awareness of EBV-negative PTLD. The clinical presentation of EBV-negative PTLD has not been as well characterised as EBV-positive cases. Further, there is limited knowledge on the clinical importance of diffuse large B-cell lymphoma (DLBCL) cell of origin subtype post-transplant. Materials and methods. We studied the role of EBV, hepatitis C (HCV) and DLBCL subtype in clinical presentation and survival in 135 post-transplant lymphomas diagnosed 1980-2006 in a population-based cohort of 10 010 Swedish solid organ transplant recipients. The lymphomas were re-evaluated according to WHO 2008, examined for EBV, and clinical data were collected from medical records. Results. Lymphoma incidence rate was 159/100 000 person-years and is also reported by lymphoma subtype. EBV-negative lymphomas constituted 48% and were associated with HCV infection (p = 0.02), bone marrow involvement (p < 0.001), and T-cell phenotype (p = 0.002). Among DLBCL, 78% were of non-germinal centre subtype, which was associated with EBV-positivity (69%, p = 0.001), early occurrence (p = 0.03), heart/liver/lung/pancreas recipients (p = 0.02), anti-T-cell globulin (p = 0.001), and tacrolimus treatment (p = 0.02). DLBCL subtypes had similar overall survival. Five-year overall survival was 42% in all treated patients. Independent poor prognostic factors were older age, B symptoms, ECOG 2-4, kidney/pancreas/heart recipients, T-cell lymphoma, and HCV-infection. Conclusions. With long follow-up, a large part of PTLD is EBV-negative, due to a high proportion of T-cell lymphomas and low of polymorphic PTLD. EBV-negative PTLD have a different clinical presentation. HCV may play an aetiological role in late-onset PTLD and was revealed as a new prognostic factor for inferior survival that needs to be confirmed in larger studies. The heavier immunosuppression in non-kidney transplantations seems to play a role in the development of non-germinal centre DLBCL. DLBCL cell of origin subtype lacks prognostic importance in the transplant setting.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Kinch, Amelie
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Baecklund, Eva
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Backlin, Carin
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Ekman, Tor
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Molin, Daniel
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Tufveson, Gunnar
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show more...
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Fernberg, Pia
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Sundström, Chris ...
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Pauksens, Karlis
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Enblad, Gunilla
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Acta Oncologica
- By the university
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Uppsala University