Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders

Aaron Rosenberg, Robin Ruthazer, Jessica K. Paulus, David M. Kent, Andrew M. Evens, Andreas K. Klein

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than MM, but improvement in survival over time outpaced that of MM over the same time period. Advanced age and elevated creatinine are associated with shorter survival. Background Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. Patients and Methods A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. Results Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). Conclusion Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.

Original languageEnglish (US)
Pages (from-to)684-692.e3
JournalClinical Lymphoma, Myeloma and Leukemia
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Plasmacytoma
Lymphoproliferative Disorders
Survival Analysis
Multiple Myeloma
Survival
Epidemiology
Muromonab-CD3
Creatinine
Organ Transplantation

Keywords

  • Multiple myeloma
  • Organ transplantation
  • Prognosis
  • PTLD
  • Survival

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders. / Rosenberg, Aaron; Ruthazer, Robin; Paulus, Jessica K.; Kent, David M.; Evens, Andrew M.; Klein, Andreas K.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 16, No. 12, 01.12.2016, p. 684-692.e3.

Research output: Contribution to journalArticle

Rosenberg, Aaron ; Ruthazer, Robin ; Paulus, Jessica K. ; Kent, David M. ; Evens, Andrew M. ; Klein, Andreas K. / Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders. In: Clinical Lymphoma, Myeloma and Leukemia. 2016 ; Vol. 16, No. 12. pp. 684-692.e3.
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abstract = "We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than MM, but improvement in survival over time outpaced that of MM over the same time period. Advanced age and elevated creatinine are associated with shorter survival. Background Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. Patients and Methods A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. Results Men comprised 71{\%} of patients; extramedullary disease was noted in 58{\%}. Novel therapeutic agents were used in 19{\%} of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55{\%}, and chemotherapy in 32{\%}. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). Conclusion Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.",
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AU - Rosenberg, Aaron

AU - Ruthazer, Robin

AU - Paulus, Jessica K.

AU - Kent, David M.

AU - Evens, Andrew M.

AU - Klein, Andreas K.

PY - 2016/12/1

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N2 - We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than MM, but improvement in survival over time outpaced that of MM over the same time period. Advanced age and elevated creatinine are associated with shorter survival. Background Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. Patients and Methods A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. Results Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). Conclusion Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.

AB - We identified in a large database 212 patients with multiple myeloma (MM) that developed after solid organ transplantation, which is a rare form of posttransplantation lymphoproliferative disorder (PTLD-MM), and we examined overall survival and prognostic factors. PTLD-MM has a worse prognosis than MM, but improvement in survival over time outpaced that of MM over the same time period. Advanced age and elevated creatinine are associated with shorter survival. Background Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. Patients and Methods A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. Results Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). Conclusion Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.

KW - Multiple myeloma

KW - Organ transplantation

KW - Prognosis

KW - PTLD

KW - Survival

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