POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS IN BRAZIL: CLINICAL-EPIDEMIOLOGICAL FEATURES, HISTOLOGIC PATTERNS, CLINICAL OUTCOMES AND PROGNOSTIC FACTORS
- 1Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
Abstract
Background: Post-transplant lymphoproliferative disorders (PTLD) are heterogeneous lymphoid and plasmacytic proliferations arising after solid organ or allogeneic hematopoietic stem cell transplantation and represent a serious transplant-related complication. Although major predisposing factors are well established, determinants of long-term survival remain uncertain. We evaluated clinical-pathological features, outcomes, and prognostic factors in a large PTLD cohort, including the potential impact of EBV tumor status, transplanted organ, and immunosuppression. Methods: This retrospective single-center study included 60 PTLD patients diagnosed at the University of São Paulo, Brazil, between January 2010 and December 2025. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. Prognostic factors were assessed by log-rank testing and Cox regression. A p-value ≤0.05 was considered significant. Results: Median age was 47 years (19–75), and 67% were male. Monomorphic PTLD accounted for 97% of cases, predominantly diffuse large B-cell lymphoma (DLBCL; 86%). Advanced-stage disease was present in 72%, B-symptoms in 42%, bulky disease ≥7 cm in 30%, ≥2 extranodal sites in 35%, central nervous system (CNS) involvement in 15%, and bone marrow infiltration in 6.8%. EBER was assessed in 43 patients and was positive in 41.8%. Kidney transplantation was most frequent (53%), followed by liver (22%), lung (13%), and heart (12%). Most patients (70%) received three or more immunosuppressive agents. Among 55 treated patients, 9.1% underwent immunosuppression reduction/switch alone, 22% received rituximab plus immunosuppression reduction, and 69% received immunochemotherapy. After a median follow-up of 97.8 months, estimated 5-year OS and PFS were 76% and 75%, respectively. EBV tumor status (p=0.485), immunosuppression intensity (p=0.887), and transplanted organ (p=0.962) did not affect OS. In multivariate analysis, CNS involvement (HR 24.1; p=0.035), bulky disease (HR 9.45; p=0.016), and relapsed/refractory disease (HR 13.6; p=0.003) independently predicted inferior OS. CNS involvement (HR 8.46; p=0.021) and bulky disease (HR 1.56; p=0.050) were also associated with shorter PFS. Conclusion: In the largest Latin American PTLD cohort reported to date, CNS involvement, bulky disease, and relapsed/refractory disease were the main independent predictors of poor survival. In contrast, EBV tumor status, transplanted organ, and intensity of immunosuppression showed no prognostic impact, suggesting that disease burden and anatomical dissemination may be more relevant for risk stratification than traditional PTLD predisposing factors.
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BibTeX
@article{caciola2026posttransplant,
title = {{POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS IN BRAZIL: CLINICAL-EPIDEMIOLOGICAL FEATURES, HISTOLOGIC PATTERNS, CLINICAL OUTCOMES AND PROGNOSTIC FACTORS}},
author = {Karina CACIOLA and Carlos Alberto DA CUNHA and Joaquim GASPARINI DOS SANTOS and Cadiele Oliana REICHERT and Hebert Fabricio CULLER and Sheilla Aparecida COELHO DA SIQUEIRA and Iberê Cauduro SOARES and Renata DE OLIVEIRA COSTA and Valéria BUCCHERI and Vanderson ROCHA and Juliana PEREIRA and Luís Alberto DE PÁDUA COVAS LAGE},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.107810},
url = {https://doi.org/10.1016/j.htct.2026.107810},
note = {CC BY},
}
RIS
TY - JOUR
TI - POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS IN BRAZIL: CLINICAL-EPIDEMIOLOGICAL FEATURES, HISTOLOGIC PATTERNS, CLINICAL OUTCOMES AND PROGNOSTIC FACTORS
AU - Karina CACIOLA
AU - Carlos Alberto DA CUNHA
AU - Joaquim GASPARINI DOS SANTOS
AU - Cadiele Oliana REICHERT
AU - Hebert Fabricio CULLER
AU - Sheilla Aparecida COELHO DA SIQUEIRA
AU - Iberê Cauduro SOARES
AU - Renata DE OLIVEIRA COSTA
AU - Valéria BUCCHERI
AU - Vanderson ROCHA
AU - Juliana PEREIRA
AU - Luís Alberto DE PÁDUA COVAS LAGE
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.107810
UR - https://doi.org/10.1016/j.htct.2026.107810
AB - Background: Post-transplant lymphoproliferative disorders (PTLD) are heterogeneous lymphoid and plasmacytic proliferations arising after solid organ or allogeneic hematopoietic stem cell transplantation and represent a serious transplant-related complication. Although major predisposing factors are well established, determinants of long-term survival remain uncertain. We evaluated clinical-pathological features, outcomes, and prognostic factors in a large PTLD cohort, including the potential impact of EBV tumor status, transplanted organ, and immunosuppression. Methods: This retrospective single-center study included 60 PTLD patients diagnosed at the University of São Paulo, Brazil, between January 2010 and December 2025. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. Prognostic factors were assessed by log-rank testing and Cox regression. A p-value ≤0.05 was considered significant. Results: Median age was 47 years (19–75), and 67% were male. Monomorphic PTLD accounted for 97% of cases, predominantly diffuse large B-cell lymphoma (DLBCL; 86%). Advanced-stage disease was present in 72%, B-symptoms in 42%, bulky disease ≥7 cm in 30%, ≥2 extranodal sites in 35%, central nervous system (CNS) involvement in 15%, and bone marrow infiltration in 6.8%. EBER was assessed in 43 patients and was positive in 41.8%. Kidney transplantation was most frequent (53%), followed by liver (22%), lung (13%), and heart (12%). Most patients (70%) received three or more immunosuppressive agents. Among 55 treated patients, 9.1% underwent immunosuppression reduction/switch alone, 22% received rituximab plus immunosuppression reduction, and 69% received immunochemotherapy. After a median follow-up of 97.8 months, estimated 5-year OS and PFS were 76% and 75%, respectively. EBV tumor status (p=0.485), immunosuppression intensity (p=0.887), and transplanted organ (p=0.962) did not affect OS. In multivariate analysis, CNS involvement (HR 24.1; p=0.035), bulky disease (HR 9.45; p=0.016), and relapsed/refractory disease (HR 13.6; p=0.003) independently predicted inferior OS. CNS involvement (HR 8.46; p=0.021) and bulky disease (HR 1.56; p=0.050) were also associated with shorter PFS. Conclusion: In the largest Latin American PTLD cohort reported to date, CNS involvement, bulky disease, and relapsed/refractory disease were the main independent predictors of poor survival. In contrast, EBV tumor status, transplanted organ, and intensity of immunosuppression showed no prognostic impact, suggesting that disease burden and anatomical dissemination may be more relevant for risk stratification than traditional PTLD predisposing factors.
SN - 2531-1379
SN - 2531-1387
ER -