PTLD-1: response to rituximab induction as a predictive marker allowing stratification into rituximab or R-CHOP consolidation in B-cell post-transplant lymphoproliferative disorder
In lymphoma arising after an organ transplant, starting with rituximab alone and then choosing between more rituximab and chemotherapy by response gave complete remission in seven of ten patients and a median survival of more than six years.
Overview
International prospective phase 2 trial of risk-stratified sequential treatment in CD20-positive post-transplant lymphoproliferative disorder after solid organ transplantation: four weekly rituximab infusions, then four further rituximab doses for patients in complete remission or four cycles of R-CHOP for all others.
111 of 126 patients responded (88 percent), 88 with a complete response (70 percent); the three-year response duration estimate was 82 percent and median overall survival 6.6 years. Grade 3 or 4 infections occurred in 34 percent and treatment-related mortality was 8 percent. Response to rituximab induction remained prognostic for survival.
- Overall response 88 percent (95% CI 81 to 93); complete response 70 percent (61 to 77).
- Three-year response duration 82 percent; median overall survival 6.6 years (95% CI 5.5 to 7.6).
- Grade 3 or 4 infections 34 percent; treatment-related mortality 8 percent.
Risk-stratified sequential treatment is the standard first-line approach to post-transplant lymphoproliferative disorder, sparing complete responders to rituximab from chemotherapy.
- Single-arm phase 2; Burkitt, T-cell and CNS disease were excluded.