Clinical and pathological prognostic markers for survival in adult patients with post-transplant lymphoproliferative disorders: BCL2 as a prognostic marker

Abstract

8073 Background: PTLD is the most serious hematological complications of solid-organ transplantation. We determined clinical and immunohistopathological prognostic factors for overall survival (OS) in patients with PTLD. Methods: Eighty-four patients with PTLD between 1980 and 2004 at University of Pittsburgh were identified. Immunohistochemistry staining was performed on tumor at diagnosis for BCL2, BCL6, cMYC, p53, PS6k, HSP90 and NFkB. Univariate associations between individual clinical and immunohistopathological features and OS were compared using Cox proportional hazard models. Survival curves were generated via the method of Kaplan-Meier. Results: The median age at the time of diagnosis of PTLD was 53 years. Thirty four percent of patients presented with early PTLD. Sixty-four percent of patients were EBV positive by in situ hybridization. Lung transplant was significantly related to grafted organ involvement (p=0.035). Lung and multiorgan transplants were associated with a higher risk for early PTLD (p=0.0033 and p=0.054), while renal transplant was associated with risk for late PTLD (p=0.0011). The median survival for all patients was 20.8 months, 95% CI: (7.4–77.6). On univariate analysis for OS, poor prognostic factors were identified: age of transplant >60 yr (p=0.02), multiorgan transplant (p=0.02), ECOG>2 (p<0.0001), grafted organ involvement and extranodal disease at the time of diagnosis (p<0.011), early PTLD (p<0.0001), and elevated white blood cell count (WBC) 1 month prior to diagnosis (p=0.01). Good prognostic factors included late PTLD, monomorphic disease, CD20 positive and rituximab use. Only BCL2 strongly correlated with prognosis (p=0.002). A final clinico-pathological model for survival was constructed using three factors: ECOG >2, elevated WBC one month prior diagnosis and BCL2 overexpression. Patients with these three risk factors had median survival of 10 days (95% CI: 0–41), in comparison with patients with none of these risk factors had median survival of 1,414 days. Conclusions: Patients who had 3 factors ECOG >2, elevated WBC one month prior diagnosis, and BCL2 overexpression in tumor tissue had worse median survival than the patients with none of these three factors. No significant financial relationships to disclose.