Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders

We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than...

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Bibliographic Details
Published in:Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2016-12, Vol.16 (12), p.684-692.e3
Main Authors: Rosenberg, Aaron S., Ruthazer, Robin, Paulus, Jessica K., Kent, David M., Evens, Andrew M., Klein, Andreas K.
Format: Article
Language:English
Subjects:
Aged
Female
Humans
Immunosuppression Therapy - adverse effects
Kaplan-Meier Estimate
Lymphoproliferative Disorders - diagnosis
Lymphoproliferative Disorders - etiology
Lymphoproliferative Disorders - mortality
Lymphoproliferative Disorders - therapy
Male
Middle Aged
Multiple myeloma
Multiple Myeloma - diagnosis
Multiple Myeloma - etiology
Multiple Myeloma - mortality
Multiple Myeloma - therapy
Organ transplantation
Organ Transplantation - adverse effects
Plasmacytoma - diagnosis
Plasmacytoma - etiology
Plasmacytoma - mortality
Plasmacytoma - therapy
Prognosis
Proportional Hazards Models
PTLD
Risk Factors
SEER Program
Survival
Survival Analysis
United States - epidemiology
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Summary:We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than MM, but improvement in survival over time outpaced that of MM over the same time period. Advanced age and elevated creatinine are associated with shorter survival. Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.
ISSN:2152-2650
2152-2669
DOI:10.1016/j.clml.2016.09.002