Long-term survival in post-transplant lymphoproliferative disorders with a dose-adjusted ACVBP regimen.

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are severe complications after solid organ transplantation with no consensus on best treatment practice. Chemotherapy is a therapeutic option with a high response and a significant relapse rate leading to a low long-term tolerance rate. Currently, most centres use anthracycline-based drug combinations, such as CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). We assessed the efficacy and safety of a dose-adjusted ACVBP (doxorubicin reduced to 50 mg/m(2), cyclophosphamide adjusted to renal function, vindesine, bleomycin, prednisone) regimen in patients failing to respond to a reduction in immunosuppressive therapy. Favourable responses were observed in 24 (73%) of the 33 treated patients. Fourteen (42%) patients died, mostly from PTLD progression. Actuarial survival was 60% at 5 years and 55% at 10 years. Survival prognostic factors were: number of involved sites (P = 0.007), clinical stage III/IV (P = 0.004), bulky tumour (P < 0.0001), B symptoms (P = 0.03), decreased serum albumin (P = 0.03) and poor performance status (P = 0.06). Both the international and the PTLD prognostic index were predictive for survival (P = 0.001 and P = 0.002, respectively). Overall 128 cycles were given. Grade 3 or 4 neutropenia was recorded after 26 (20%) chemotherapy cycles in 19 (58%) patients. Forty-one (32%) infections were recorded in 26 (79%) patients. This study demonstrated that an individual dose-adjustment of ACVBP regimen was manageable in PTLD patients and favourably impacted on long-term survival.

• Authors: Cécile Fohrer, Sophie Caillard, Argyro Koumarianou, Bernard Ellero, Marie-Lorraine Woehl-Jaeglé, Carole Meyer, Eric Epailly, Marie-Pierre Chenard, Bruno Lioure, Shanti Natarajan-Ame, Frédéric Maloisel, Philippe Lutun, Romain Kessler, Bruno Moulin, Jean-Pierre Bergerat, Philippe Wolf, Raoul Herbrecht
• Journal: British journal of haematology (Br J Haematol) Vol. 134 Issue 6 Pg. 602-12 (Sep 2006) ISSN: 0007-1048 [Print] England
• PMID: 16889621 (Publication Type: Journal Article)

Chemical References

• Bleomycin
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Vindesine
• Prednisone

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bacterial Infections (etiology, mortality)
• Bleomycin (adverse effects, therapeutic use)
• Cyclophosphamide (administration & dosage, adverse effects, therapeutic use)
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects, therapeutic use)
• Drug Administration Schedule
• Female
• Humans
• Lymphoproliferative Disorders (drug therapy, mortality)
• Male
• Middle Aged
• Organ Transplantation
• Postoperative Complications (drug therapy, mortality)
• Prednisone (administration & dosage, adverse effects, therapeutic use)
• Survival Rate
• Treatment Outcome
• Vincristine (administration & dosage)
• Vindesine (adverse effects, therapeutic use)