Risk Factors and Predictive Scoring System For Post-Transplant Lymphoproliferative Disorder after Hematopoietic Stem Cell Transplantation

A. Fujimoto, Nobuhiro Hiramoto, Satoshi Yamasaki, Yoshihiro Inamoto, Naoyuki Uchida, Tetsuo Maeda, Takehiko Mori, Yoshinobu Kanda, Tadakazu Kondo, Souichi Shiratori, Shigesaburo Miyakoshi, Ken Ishiyama, Kazuhiro Ikegame, Yoshiko Matsuhashi, J. Tanaka, Tatsuo Ichinohe, Yoshiko Atsuta, M. Ogata, Ritsuro Suzuki

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


We analyzed data from 64,539 consecutive patients in the Japanese national transplant registry, including 40,195 after allogeneic hematopoietic stem cell transplantation (HSCT), 24,215 after autologous HSCT and 129 after syngeneic HSCT, of whom 299 developed Epstein-Barr virus-positive post-transplant lymphoproliferative disorder (PTLD). The probability of developing PTLD at 2 years post-HSCT was .79% after allogeneic transplantation, .78% after syngeneic transplantation, and .11% after autologous transplantation. The following variables were identified as risk factors after allogeneic HSCT in multivariate analysis: antithymocyte globulin (ATG) use in a conditioning regimen, ATG use for acute graft-versus-host disease (GVHD) treatment, donor other than an HLA-matched related donor, aplastic anemia, second or subsequent allogeneic HSCT, the most recent year of transplantation, and acute GVHD. The probability at 2 years increased particularly after 2009 (1.24%) than before 2009 (.45%). To stratify the risk of PTLD before allogeneic HSCT, we developed a novel 5-point scoring system based on 3 pretransplant risk factors: ATG use in a conditioning regimen (high dose, 2 points; low dose, 1 point), donor type (HLA-mismatched related donor, 1 point; unrelated donor, 1 point; cord blood, 2 points), and aplastic anemia (1 point). Patients were classified into 4 risk groups according to the summed points: low risk (0 or 1 point), intermediate risk (2 points), high risk (3 points), and very high risk (4 or 5 points) groups, with probabilities at 2 years of .3%, 1.3%, 4.6%, and 11.5%, respectively. Our scoring system is useful for predicting patients at high risk for PTLD. Careful observation and close monitoring of Epstein-Barr virus reactivation are warranted for these high-risk patients.

Original languageEnglish
Pages (from-to)1441-1449
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Issue number7
Publication statusPublished - 2019 Jul


  • Hematopoietic stem cell transplantation
  • Post-transplant lymphoproliferative disorder
  • Predictive scoring system

ASJC Scopus subject areas

  • Hematology
  • Transplantation


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