Cancer Res Treat.  2024 Jan;56(1):305-313. 10.4143/crt.2023.647.

Incidence and Features of Lymphoid Proliferation and Lymphomas after Solid Organ or Hematopoietic Stem Cell Transplantation in a National Database Cohort

• Hahn SM
• Lee M
• Hyun J
• Lim S
• Kang JM
• Ahn JG
• Joo DJ
• Jung I
• Ihn K

• KMID: 2550345
• DOI: http://doi.org/10.4143/crt.2023.647

Abstract

Purpose
Post-transplantation lymphoproliferative disorders (PTLDs) after hematopoietic stem transplantation (HCT) or solid organ transplantation (SOT) result in poorer outcomes, including death. There are limited large cohort data on the incidence and natural course of PTLD in Asians.
Materials and Methods
We investigated PTLD using Korean national health insurance claims data of 47,518 patients who underwent HCT or SOT in 2008-2020. Patient demographics, time and type of PTLD diagnosis, type of PTLD treatment, and death data were collected. We used Fine and Gray subdistribution hazard models to calculate the cumulative incidence and risk factors for PTLD.
Results
During median follow-up of 5.32 years, PTLD occurred in 294 of 36,945 SOT patients (0.79%) and 235 of 10,573 HCT patients (2.22%). Cumulative incidence of PTLD were 0.49% at 1 year, 1.02% at 5 years, and 1.50% at 10 years post-transplantation. Age < 20 years (subdistribution hazard ratio [SHR] of 1.67 in age 10-19, SHR 1.51 in age 0-9), HCT (SHR 3.02), heart transplantation (SHR 2.27), and liver transplantation (SHR 1.47) were significant risk factors for PTLD. The presence of PTLD was associated with an increased risk of death (hazard ratio of 2.84). Overall, 5-year survival of PTLD patients was 68.9% (95% confidence interval, 64.9 to 73.2).
Conclusion
We observed a steady increase in PTLD over 10 years after HCT or SOT in this large cohort study. Pediatric age group, HCT, liver transplantation, and heart transplantation were suggested to be risk factors for PTLD, and PTLD was associated with a higher risk of death.

Keyword

Lymphoproliferative disorders; Lymphoma; Organ transplantation; Hematopoietic stem cell transplantation

Figure

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  Fig. 1. Selection of the study population.

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  Fig. 2. Cumulative incidence of post-transplantation lymphoproliferative disorder according to sex (A), age group (B), transplanted organ among solid organ transplant recipients (C), and type of transplantation (hematopoietic stem cell transplantation [HCT] or solid organ transplantation [SOT]) (D).

Reference

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