期刊
BLOOD
卷 113, 期 20, 页码 4992-5001出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2008-09-178046
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资金
- NCI [CP-51027, CP-51028, P01-HL36444, P01-CA18029, P01CA102542, P01-CA15704]
- Intramural Research Program of the NIH
- Public Health Service [U24-CA76518]
- National Institute of Allergy and Infectious Diseases
- National Heart, Lung and Blood Institute
- Office of Naval Research
- Health Services Research Administration [K23 CA82350-05]
- Abbott Laboratories
- Aetna
- American International Group
- American Red Cross
- Amgen
- Medical College of Wisconsin
- AnorMED
- Astellas Pharma US
- Baxter International
- Berlex Laboratories
- Biogen IDEC
- BloodCenter of Wisconsin
- Blue Cross and Blue Shield Association
- Bristol-Myers Squibb Company
- BRT Laboratories
- Cangene
- Celgene
- CellGenix
- Cell Therapeutics
- CelMed Biosciences
- Cylex
- Cytonome
- CytoTherm
- DOR BioPharma
- Dynal Biotech
- Invitrogen Company
- Enzon Pharmaceuticals
- Gambro BCT
- Gamida Cell
- Genzyme
- Gift of Life Bone Marrow Foundation
- GlaxoSmithKline
- Histogenetics
- HKS Medical Information Systems
- Kirin Brewery
- Merck Company
- The Medical College of Wisconsin
- Millennium Pharmaceuticals
- Miller Pharmacal Group
- Milliman USA
- Miltenyi Biotec
- MultiPlan
- National Marrow Donor Program
- Nature Publishing Group
- Novartis Pharmaceuticals
- Osiris Therapeutics
- Pall Medical
- Pfizer
- Pharmion
- PDL BioPharma
- Roche Laboratories
- Sanofi- aventis
- Schering Plough
- StemCyte
- StemSoft Software
- SuperGen
- Sysmex
- The Marrow Foundation
- THERAKOS
- University of Colorado Cord Blood Bank
- ViaCell
- ViraCor Laboratories
- Wellpoint
- Zelos Therapeutics
We evaluated 26 901 patients who underwent allogeneic hematopoietic cell transplantation (HCT) at 271 centers worldwide to define patterns of posttransplantation lymphoproliferative disorders (PTLDs). PTLDs developed in 127 recipients, with 105 (83%) cases occurring within 1 year after transplantation. In multivariate analyses, we confirmed that PTLD risks were strongly associated (P <.001) with T-cell depletion of the donor marrow, antithymocyte globulin (ATG) use, and unrelated or HLA-mismatched grafts (URD/HLA mismatch). Significant associations were also confirmed for acute and chronic graft-versus-host disease. The increased risk associated with URD/HLA-mismatched donors (RR = 3.8) was limited to patients with T-cell depletion or ATG use (P = .004). New findings were elevated risks for age 50 years or older at transplantation (RR = 5.1; P <.001) and second transplantation (RR = 3.5; P <.001). Lower risks were found for T-cell depletion methods that remove both T and B cells (alemtuzumab and elutriation, RR = 3.1; P = .025) compared with other methods (RR = 9.4; P = .005 for difference). The cumulative incidence of PTLDs was low (0.2%) among 21 686 patients with no major risk factors, but increased to 1.1%, 3.6%, and 8.1% with 1, 2, and more than 3 major risk factors, respectively. Our findings identify subgroups of patients who underwent allogeneic HCT at elevated risk of PTLDs for whom prospective monitoring of Epstein-Barr virus activation and early treatment intervention may be particularly beneficial. (Blood. 2009; 113: 4992-5001)
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