380 | FIRST‐LINE THERAPY WITH RITUXIMAB VERSUS RITUXIMAB‐CHOP IN POST‐TRANSPLANT MONOMORPHIC DIFFUSE LARGE B‐CELL LYMPHOMA: A LARGE SERIES FROM SPANISH GROUP OF LYMPHOMA (GELTAMO)

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Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a rare and serious complication of immunosuppression after solid organ or allogeneic stem cell transplantation.Sequential treatment based on rituximab induction followed by either continuation of rituximab or addition of chemotherapy depending of response (risk-stratified sequential therapy = RSST) has drastically improved overall survival (OS) in the last decade.However, little is known about the causes of death (CODs) in PTLD patients.Methods: We analyzed data from patients (n = 555) included in the French K-VIROGREF registry (national registry of immunosuppressive-related cancers among transplanted patients).CODs were categorized as being a result of lymphoma, treatment related, other causes, other cancers, or unknown.For subgroup analysis, PTLD and treatment related deaths were combined into PTLD-related deaths, and other causes and other cancers into deaths unrelated to PTLD. Results:The median age at PTLD diagnosis was 59 years (IQR: 45-68).Transplanted organs were mostly kidney (57%), followed by liver (17%).The majority of the patients had a monomorphic diffuse large B-cell lymphoma (DLBCL) (67%), and 19% of the patients presented primary central nervous system (CNS) lymphoma.RSST was given to 51% of the patients.After a median follow-up of 5 years, the 5-year OS was 54.6% (95% CI: 50.2-59.4)in the overall cohort.Among 244 deaths, PTLD was the main COD with a 5-year cumulative incidence of 21.1%, followed by other causes (10.8%), treatment-related mortality (9.8%), unknown (2.9%) and other cancer (0.9%) (Figure 1).Between 5 and 10 years after PTLD diagnosis, almost all deaths were attributed to causes unrelated to PTLD.There was no difference in the cumulative incidence of lymphomarelated or non-lymphoma-related deaths by sex, transplanted organ, timing of onset of PTLD (early vs. late PTLD), histology (monomorphic B-cell vs. polymorphic) and EBV status.The cumulative incidence of lymphoma-related mortality increased more rapidly with International Prognostic Index (IPI) 3 to 5 versus IPI 0 to 2 (44.4% vs. 21.7%),primary CNS lymphoma versus systemic lymphoma (48% vs. 26.7%)and upfront chemotherapy versus RSST (36.7% vs. 24.6%).The 5-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group, for IPI (including IPI score 0-2, 21.7% vs. 10.6%), for patients who failed to achieve event-free survival within 24 months (EFS24) from PTLD diagnosis (70% vs. 13.1%)but not for patients who achieved EFS24 (1% vs. 10.2%). Conclusion:This study provides a comprehensive description of COD in patients with PTLD, with lymphoma representing the leading one.The high rate of PTLD-unrelated deaths and its continuous increase over the time reflects comorbidities and the immunosuppressive state of this population.

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