Hodgkin lymphoma post-transplant lymphoproliferative disorder (HL-PTLD) is an uncommon PTLD with unclear prognosis and differences between HL-PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL-PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL-SEER). Overall survival (OS) and disease-specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL-PTLD diagnosis was 88 months. When compared with HL-SEER, patients with HL-PTLD were older (median age, 52 vs. 36 years, P = 0.001), more likely male (73% vs. 54%, P<0.001), Caucasian (81% vs. 70%, P=0.02), and had extranodal disease (42% vs. 3%, P<0.001). Five-year OS for patients with HL-PTLD was 57% versus 80% for HL-SEER (P<0.001); DSS was also inferior (P<0.001). For patients with HL-PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR=0.36, P<0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR=2.94, P=0.001 and 2.01, P=0.04) versus HL-specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR=1.26/decade P<0.001 and 1.64/0.1 mg/dL increase P=0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10-year OS rates of 79%, 53%, and 11%, respectively (P<0.001). Altogether, HL-PTLD patients have inferior survival when compared with HL-SEER. Furthermore, treatment with HL-specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival.
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