Risk factors for the incidence of PTLD and the mortality due to PTLD after hematopoietic cell transplantation.

Abstract Background Posttransplant lymphoproliferative disorder (PTLD) is a potentially serious complication that occurs following hematopoietic cell transplantation where B cells transformed by Epstein-Barr virus (EBV) proliferate uncontrollably. It is unknown whether risk factors for the incidence of PTLD are identical to risk factors for the mortality due to PTLD, despite the latter being a clinically more important outcome. Objectives We sought to determine the risk factors influencing the incidence of PTLD and the risk factors influencing the mortality due to PTLD. Study Design Here we studied potential risk factors for the incidence of and the mortality due to PTLD in a cohort of 1184 allogenic hematopoietic cell transplant recipients. All patients were predisposed to PTLD as their graft-vs-host disease (GVHD) prophylaxis included antithymocyte globulin. Results PTLD incidence was 9.0%. Mortality due to PTLD was 1.1%. In multivariate analysis, risk factors for PTLD incidence were D+R- EBV serostatus (donor seropositive and recipient seronegative for EBV) (subhazard ratio (SHR)=3.3, p=0.002), donor other than HLA-matched sibling donor (non-MSD) (SHR=1.7, p=0.029), total body irradiation (SHR=3.3, p=0.008), and the absence of GVHD (SHR=3.3, p Conclusion Some risk factors for the incidence of PTLD are identical to the risk factors for the mortality due to PTLD (D+R- serostatus) whereas other risk factors are disparate. Specifically, total body irradiation was a risk factor for PTLD incidence but not for PTLD mortality, the absence of GVHD was a risk factor for PTLD incidence whereas the presence of GVHD was possibly a risk factor for PTLD mortality, and blood stem cell graft was possibly a risk factor for PTLD incidence whereas marrow graft was a risk factor for PTLD mortality.