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| |  ICML: New Prognostic Index Proposed for Post-transplant Lymphoproliferative Disorders By Claudia Orellana LUGANO, SWITZERLAND -- June 19, 2002 -- A clinico-pathological study on post-transplant lymphoproliferative disorders was presented by French researchers at the 8th International Conference on Malignant lymphoma in Lugano, Switzerland, on the 15th of June. The researchers evaluated the International Prognostic Index (IPI) and found that it is not the most accurate predictor of survival in patients with post-transplant lymphoproliferative disorders. The drawback of previous attempts to identify prognostic factors has been the relatively small sample size and heterogeneity of the data on which they have been based. From December 1987 to December 2001, researchers at Pitié-Salpêtrière Hospital, in Paris, France, followed 47 men and 20 women, median age was 46 years (range 15 to 72), and analysed their clinico-pathological data. The organs transplanted were 28 kidneys, seven lungs, five livers and three combined heart and lung transplantations. Post-transplant lymphoproliferative disorders appeared in a median of 1490 days (range 52-10,032) after transplantation. Sixty cases were of the B phenotype and 53 out of these were clonal. Univariate and multivariate analyses were performed for IPI prediction factors. "We tried to find some prognostic factors for the overall survival, because we were not convinced by IPI ones. We used a relatively large number of patients given the rarity of the disease ", said first author Sylvain Choquet, from the Clinical Hematology Unit at Pitié-Salpêtrière Hospital. Some of the prognostic factors for prolonged survival evaluated in the monovariate analysis were: B phenotype (p=0.02), monoclonality (p=0.02), Epstein-Barr Virus status of the tumor (p=0.01), only one localization versus more than one (p=4.5x10-7) and personal status 0-1 versus 2-4 (p=3x10-7). Neither the lactic dehydrogenase levels (elevated versus normal) (p=0.5), nor the Ann Arbor staging (I-II versus III-IV) (p=0.13) were significantly linked to survival. In a multivariate analysis, the personal status had a p=1.3x10-5, while the number of sites affected by the disease (one vs. more than one) had a p value of 5.9x10-3. As a result of these findings, the authors of the study propose an index comprising just two factors -- more than one involved site and personal status 3 or 4. Level A (representing the longest survival prognosis) is proposed for those not having any of these factors, level B for those having one of the factors, and level C for those having both. "Statistically, the difference was quite big. With the IPI we have four different levels-the first and the fourth added very few patients. The two main IPI levels [projected survival curves] crossed each other, which was not much use in terms of their predictive value. That’s why we are now proposing this new predictive index," Prof. Choquet explained.
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