LAUSR

Introduction—Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of solid organ transplantation (SOT). Histologic heterogeneity and lack of treatment standards have made evaluating clinical outcomes in specific patient populations difficult. This systematic literature review investigates the impact of PTLD histologic subtype on survival in a large dataset. Methods—Case series were identified on PubMed using the search terms “post-transplant lymphoproliferative disorder/disease,” “PTLD”, and “solid organ transplantation,” with additional publications identified through reference lists. Patient characteristics, immunosuppressive regimen, treatment, survival, and follow-up time of 265 cases were extracted from 94 articles and combined with 11 cases from our institution. Patients with recorded subtype were included in Kaplan-Meier survival analysis (n=234). Cox proportional hazard regression analyses identified predictors of overall survival (OS) for each subtype and B-cell subgroup. Results—OS differed significantly between monomorphic T-cell neoplasms (median 9 months) and polymorphic, monomorphic B-cell, and Hodgkin-type neoplasms, for which median OS was not reached (p=0.0001). Significant differences in OS among B-subgroups were not detected, but there was a trend towards decreased survival in Burkitt-type PTLD. Kidney transplant and reduction of immunosuppression were associated with increased OS in multivariable analysis in B-cell neoplasms. Immunosuppression with azathioprine was associated with decreased OS in Tcell neoplasms, while radiotherapy was associated with improved OS in that subtype. Corresponding author: Jean L. Koff, MD, [email protected], 1365 Clifton Rd NE, Building B, Suite 4300, Atlanta, GA 30322, Telephone: 404.778.5210, Fax: 404.778.3366. Conflicts of interest: There are no conflicts of interest disclosures from any authors. Author contributions: All authors contributed extensively to the work presented in this paper. EKW and JLK designed the study. CRF contributed conceptual advice. JL and JLK conducted systematic literature review. JL, XZ, and JMS performed statistical analyses. JLK and JL interpreted the data and prepared the manuscript, edited by EKW and CRF. HHS Public Access Author manuscript Cancer. Author manuscript; available in PMC 2019 June 01. Published in final edited form as: Cancer. 2018 June 01; 124(11): 2327–2336. doi:10.1002/cncr.31339. A uhor M anscript