Curtis et al identified risk factors associated with posttransplant lymphoproliferative disorders (PTLD) in patients who undergo bone marrow transplantation. These risk factors can help identify patients who may benefit from a change in therapy. The authors are from multiple institutions in the United States and Europe.
Parameters:
(1) T cell depletion method
(2) donor match
(3) antithymocyte globulin
(4) anti-CD3 monoclonal antibody 64.1 given for treatment of acute graft vs host disease (GVHD)
|
Parameter |
Finding |
Points |
|
T cell depletion method |
anti-T cell monoclonal antibodies |
1 |
|
|
anti-T and NK cell monoclonal antibodies |
1 |
|
|
E rosetting |
1 |
|
|
other |
0 |
|
|
none |
0 |
|
donor match |
unrelated |
1 |
|
|
related with >= 2 HLA mismatch |
1 |
|
|
related with 0 or 1 mismatch |
0 |
|
antithymocyte globulin |
prophylaxis for acute GVHD |
1 |
|
|
therapy for acute GVHD |
1 |
|
|
neither |
0 |
|
anti-CD3 monoclonal antibody |
given for acute GVHD |
1 |
|
|
not given for acute GVHD |
0 |
|
|
not given |
0 |
total risk score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score: 4
• The higher the risk score the greater the risk of developing a lymphoproliferative disorder.
• The increased risk appears to be associated with altered immunity or T-cell regulatory mechanisms.
|
Risk Score |
Rate of PTLD |
|
0 |
0.5% |
|
1 |
1.7% |
|
2 |
8% |
|
3 or 4 |
22% |
from Figure 2, page 2212
Other risk factors identified:
(1) development of GVHD grades II, III or IV
(2) condition regimen included radiation
(3) extensive chronic GVHD (risk for late onset PTLD)
Specialty: Hematology Oncology, Surgery, general
