-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

443 Post-Transplant Lymphoproliferative Disorders (PTLD) in Real Life: Data from the French K-Virogref Registry on 525 Adult PatientsClinically Relevant Abstract

Program: Oral and Poster Abstracts
Type: Oral
Session: 627. Aggressive Lymphomas: Clinical and Epidemiological: Treatment to Best Outcomes: Find the Right Therapy for the Right Patient
Hematology Disease Topics & Pathways:
Hodgkin lymphoma, adult, Lymphomas, non-Hodgkin lymphoma, B Cell lymphoma, Combination therapy, Diseases, indolent lymphoma, aggressive lymphoma, Therapies, therapy sequence, Lymphoid Malignancies, Study Population, Human
Sunday, December 10, 2023: 10:30 AM

Antoine Tichadou1*, Elise Toussaint2*, Luc Matthieu Fornecker3*, Veronique Morel4*, Inès Boussen5*, Damien Roos Weil, MD, PhD6*, Marine Baron7*, Madalina Uzunov, MD8*, Laetitia Souchet9*, Louise Roulin, MD10*, Nabih Azar, MD11*, Stéphane Lepretre12*, Bijou Fontanet13*, Caroline Jacquet, MD14*, Eric Durot15*, David Boutboul, MD, PhD16*, Felipe Suarez, MD, PhD17, Thomas Cluzeau, M.D.18*, Mohamed Touati19*, Emmanuel Bachy, MD, PhD20*, Roch Houot, MD, PhD21*, Fabrice Jardin, MD PhD22*, Romain Guieze, MD, PhD23*, Loic Ysebaert, MD, PhD24*, Laure Farnault de Lassus25* and Sylvain Choquet26*

1Assistance Publique HôPitaux De Marseille, Marseille, FRA
2Clinical Hematology, CHU Strasbourg, STRASBOURG, FRA
3Hematology, ICANS, Strasbourg, FRA
4Clinical Hematology, Pitie-Salpetriere Hospital, APHP, Sorbonne Universite, Paris Cedex 13, FRA
5Clinical Hematology, Pitie-Salpetriere hospital, APHP, Sorbonne Universite, Paris, FRA
6Clinical Hematology, APHP, La Pitié Salpétriere, Sorbonne Universite, Paris, FRA
7Clinical Hematology, Hôpital Pitié Salpétrière, APHP, Sorbonne Universite, Paris, FRA
8Clinical hematology, Pitie-Salpetriere Hopstal, APHP, Sorbonne Universite, Paris, FRA
9Pitie Salpetriere Hospital, APHP, Sorbonne Universite, Paris, FRA
10Henri Mondor Hospital, APHP, Creteil, FRA
11Apheresis, La Pitié Salpétrière Hospital, APHP, Sorbonne Universite, Paris, France
12centre henri becquerel, Rouen, FRA
13Institut Bergonié, Bordeaux, France
14CHU de Nancy, Vandoeuvre Les Nancy, FRA
15CHU Reims, Reims Cedex, France
16Service d'Immunopathologie Clinique, Saint Louis hospital, AP-HP, Paris, Paris, France
17Necker Hospital (APHP), Paris, FRA
18Département d'Hématologie Clinique, Université Cote d'Azur, CHU Nice, Nice, France
19Hématologie Clinique et Hospitalisation à domicile, CHU Limoges, LIMOGES CEDEX 1, France
20Hematology Department, Lyon Sud Hospital, Pierre-Bénite, France
21Clinical hematology, CHU Rennes, Rennes, France
22Centre Henri Becquerel, Rouen, France
23CHU Estaing, Clermont Ferrand, FRA
24Hematology Department, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
25Clinical Haematology, CHU Marseille, Marseille, France
26Clinical Hematology, Pitie-Salpetriere hospital, APHP, Sorbonne Universite, Paris, France


Post-transplant lymphoproliferative disorders (PTLD) are rare and severe complications of organ or allogeneic stem cell transplants (AST), often linked to EBV. The recommended first-line management of systemic PTLD, in addition to lowering immunosuppression, currently consists of response-tailored treatment (RTT): monotherapy with rituximab (R) and, in case of CR, a continuation of rituximab as monotherapy (RM), otherwise 4 courses of R-CHOP. The data in the literature are limited to a few very rare prospective studies and limited series, generally monocentric.

Patients and methods

The French national K-virogref database, supported by the French Institute against Cancer (INCa), started in September 2013, gathers data from PTLDs confirmed by biopsy and re-reading in the Lymphopath network. Data from 10 years of this registry have been analyzed.


A total of 525 adult patients are analyzed, the median age of transplant is 44 years, that of diagnosis of PTLD 58 years, 63% are men. Transplants are 61% kidneys, 17% livers, 6% lungs, 6% hearts, 8% stem cells. The median time from transplant to diagnosis of PTLD is 97 months, with 16% of diagnosis within the first year. The histology is of early lesion type in 4.6%, polymorphic in 12% and of lymphoma type in 83.3%, 46.7% are linked to EBV. Of the total 435 are systemic and 90 (17%) are localized to the central nervous system (CNS); predictors of CNS PTLD are later age at transplant (52 years vs 43 years), male gender ( p=1.10-3), a kidney transplant (69% vs 60%), CNS PTLDs are more often late after the transplant, more often of the lymphoma type and almost always linked to EBV (97.8%). The EBV status of the recipient at the time of transplantation was known in 242 cases, of which 50 were EBV negative; the negative EBV status is linked to an earlier age at diagnosis (43 years vs 58 years), a shorter time between transplant and diagnosis (11.5 months vs 66.5), more often early forms, more frequent localization in the graft (24% vs 9%), better survival. The median overall survival (OS) of all patients is 2700 days, tumor EBV status has no influence on OS, progression-free survival (PFS) is 1500 days. Median survivals are 2600 days for AST, 4600 for hearts, 5400 for lungs and not reached (NR) for livers and kidneys. Among the classic prognostic criteria, the IPI is not discriminating between 0 and 2, whereas the personal status is clearly discriminating (cf figure). Of the patients CD20+ without CNS localization nor Burkitt, treatment data were known for 274 patients: 27% received only immuno-chemotherapy (IC), 38% had RM and 35% R then R-CHOP. Survival is identical between IC and R then R-CHOP, with less chemotherapy in the sequential treatment, and is significantly higher (p=0.011) for RM, the RTT has a trend to a better OS than IC (p=0.062). In the event of chemotherapy, the use of an anthracycline has a better OS (median NR vs 750 days).


To our knowledge, this is the largest series of PTLD presented to date. The results of OS are similar to those presented in the prospective studies with selected patients and our data confirm the interest of RTT, with in case of chemotherapy, the need to use an anthracycline. The most discriminating and simplest prognostic criterion is PS. However, this very large series only concerns adult patients and cannot describe real-life pediatric PTLD.

Disclosures: Roulin: Kitegilead: Other: Conference speaker and travel grants, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Scientific advisory board; BMS: Consultancy, Other: Conference speaker, Speakers Bureau. Azar: Sanofi: Consultancy, Honoraria; Janssen: Consultancy. Cluzeau: Astellas: Honoraria; Bristol Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: support attending meetings/travel; BluePrint: Consultancy; Servier: Consultancy, Honoraria, Other: support attending meetings/travel; Agios: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: support attending meetings/travel; Jazz Pharma: Consultancy, Honoraria; AbbVie: Consultancy, Other: support attending meetings/travel; Incyte: Honoraria; Pfizer: Other: support attending meetings/travel; Syro: Honoraria; Takeda: Honoraria; Keros: Honoraria; Gilead: Other: support for attending meetings. Bachy: Novartis: Honoraria, Other: Personal Fees; Bristol Myers Squibb: Honoraria, Other: Personal Fees, Research Funding; Takeda: Honoraria; Incyte: Honoraria; Pfizer: Honoraria, Other: Personal Fees; Hospices Civils de Lyon Claude Bernard Lyon 1 University: Current Employment; Amgen: Research Funding; Kite, a Gilead Company: Honoraria, Other: Personal Fees; Roche: Consultancy, Honoraria. Jardin: Janssen, Gilead, AbbVie, F. Hoffmann-La Roche Ltd, BMS, Takeda: Honoraria. Ysebaert: Abbvie: Honoraria, Research Funding, Speakers Bureau; Beigene: Honoraria, Research Funding, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Gilead/Kite: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; BMS/Celgene: Consultancy, Honoraria. Choquet: Atara: Consultancy; Pierre Fabre: Consultancy; Novartis: Consultancy; Gilead kite: Consultancy; Janssen: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Takeda: Consultancy, Honoraria.

*signifies non-member of ASH