Plasma Cell Myeloma and Plasmacytoma-like Post-transplant Lymphoproliferative Disorders: A Survival Analysis in the Scientific Registry of Transplant Recipients.
Abstract: While recent
studies and trials in post-transplant lymphoproliferative disorders (PTLD) have yielded
important information regarding treatment and prognosis, relatively little is known
about the rare subtypes plasmacytoma and plasma cell myeloma PTLD (PTLD-MM). Patients
were identified in the Scientific Registry of Transplant Recipients between 1999-2011,
overall survival (OS) estim... read moreated, and treatment trends evaluated. The effects of patient
characteristics on OS were evaluated with Cox proportional hazards models. OS in PTLD-MM
was compared to matched controls with multiple myeloma (MM) from the Surveillance,
Epidemiology and End Results program. 214 patients with PTLD-MM were identified. Median
OS in the whole cohort was 2.4 years. Median OS had not been reached in those diagnosed
later in the study period, compared to < 2years in those diagnosed earlier (aHR 0.64,
p=0.05). Advanced age, creatinine>2, Caucasian race and the use of OKT3 as an
induction immunosuppressive agent were statistically significantly associated with
diminished survival; extramedullary disease and poor performance status were nearly
significant. When compared to matched controls, OS in PTLD-MM is worse than in MM (aHR
1.6, p<0.001), though improvement in OS over the last decade are more pronounced in
PTLD-MM than in MM (p for interaction 0.02). Age at diagnosis, elevated creatinine, race
and OKT3 were all associated with worse survival in patients with PTLD-MM. In contrast
to prior studies, extramedullary disease was associated with increased risk of death.
PTLD-MM is a rare disorder with poor prognosis, though dramatic improvements in OS over
the last decade have outstripped those made in MM over the same time
Thesis (M.S.)--Tufts University, 2014.
Submitted to the Dept. of Clinical & Translational Science.
Advisors: Andreas Klein, and Robin Ruthazer.
Committee: Andreas Klein, Robin Ruthazer, David Kent, and Jessica Paulus.
Keyword: Oncology.read less