DA-EPOCH-R for post-transplant lymphoproliferative disorders.

LYMPHOPROLIFERATIVE disorders; CELL proliferation; IMMUNOSUPPRESSION; IMMUNOTHERAPY; IMMUNOLOGICAL deficiency syndromes; GENETICS; THERAPEUTICS

Background Post-transplant lymphoproliferative disorders ( PTLD) are a potentially fatal group of neoplasms arising in an immunodeficient environment. Although the cornerstone of treatment is reduced immunosuppression ( RI), advanced cases often warrant treatment with chemoimmunotherapy. The chemoimmunotherapy regimen of dose-adjusted ( DA)- EPOCH-R is superior to R- CHOP in HIV associated aggressive lymphomas, suggesting that it might also be favorable in the setting of PTLD. Methods We performed a retrospective analysis of patients with advanced monomorphic PTLD treated with first line DA- EPOCH-R in addition to RI at our institution from 2003-2016. Results Seven patients were included. Mean age was 51 and mean time from transplant to diagnosis was 71 months. Six of the seven patients received a kidney transplant, six had stage III or IV disease, six had tumors that were EBV positive, and six completed therapy. All six patients who completed therapy achieved a complete response. Mean PFS and OS were 46.6 and 52.6 months, respectively. Treatment was well-tolerated with no significant treatment related morbidity or mortality. Conclusions Our findings support several observations in the literature that DA- EPOCH-R is efficacious and well-tolerated for the treatment of advanced, monomorphic PTLD. [ABSTRACT FROM AUTHOR]