Abstract: SA-PO1086
Chronic Lymphocytic Leukemia in Solid-Organ Transplant Recipients: A Single-Center Experience
Session Information
- Transplantation: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Cholin, Liza, The Ohio State University, Columbus, Ohio, United States
- Pesavento, Todd E., The Ohio State University, Columbus, Ohio, United States
- Singh, Priyamvada, The Ohio State University, Columbus, Ohio, United States
Background
To date, only two case series on chronic lymphocytic leukemia (CLL) in solid-organ transplants (SOT) has been published which showed an increased risk for severe infections and mortality. The aim of our study was to add to the limited literature on this topic, by evaluating the overall safety of transplanting such patients.
Methods
A 10 year retrospective chart review was performed to identify patients with a diagnosis of CLL who had undergone SOT at a large transplant center. Post-transplant outcomes including infectious complications, graft loss, and mortality were reviewed.
Results
A total of 10 CLL patients were studied: 5 had a CLL diagnosis pre-SOT, and 5 were diagnosed with CLL post-SOT (table 1). All kidney transplant recipients received anti-thymocyte globulin for induction, while liver transplant recipients received either Basiliximab or steroids. Maintenance immunosuppression (IS) therapy amongst the SOT recipients was similar, with 8 out of 10 patients receiving a calcineurin-inhibitor and mycophenolate derivative. Average follow up for pre-SOT CLL patients was 2.9 years (min 1, max 6) with 1 out of 2 deaths attributed to an infectious complication (COVID). Post-SOT CLL patients had a mean of 9 years between transplantation and CLL diagnosis. On an average follow up of 2.8 (min 0, max 7) years after CLL diagnosis, 3 out of 5 post-SOT CLL patients had death as an outcome.
Conclusion
Short-term outcomes in SOT recipients with a diagnosis of CLL prior to transplantation appear acceptable. However, SOT recipients who developed CLL post-transplantation seem to have an increased mortality risk. Infectious complications are a known cause for increased morbidity and mortality in CLL patients. As such, reduction in maintenance IS therapy in patients who are years out from transplantation may allow for improved outcomes.
Outcomes of patients with CLL diagnosis
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | Patient 7 | Patient 8 | Patient 9 | Patient 10 | |
| Type of transplant | Living kidney | Living kidney | DBD kidney | DCD liver | DBD liver | DBD kidney-pancreas | DBD kidney-pancreas | Living kidney | DBD liver | DBD liver |
| Demographics | 52 y.o., male, white | 63 y.o., male, white | 71 y.o., female, white | 66 y.o., male, white | 59 y.o., female, white | 37 y.o., male, white | 59 y.o., male, white | 42 y.o., female, black | 64 y.o., male, black | 63 y.o., female, white |
| Years from CLL diagnosis to transplant (if pre-SOT) | 0 | 5 | 17 | 3 | 4 | N/A | N/A | N/A | N/A | N/A |
| Years from transplant to CLL diagnosis (if post-SOT) | N/A | N/A | N/A | N/A | N/A | 25 | 2 | 2 | 7 | 9 |
| Years since transplant | 6 | 4 | 1.5 | 2 | 1 | 27 | 9 | 6 | 7 | 10 |
| Infectious complications | COVID pneumonia | No | Septic arthritis, recurrent UTIs | No | CMV viremia, COVID, chronic foot wound | No | Sepsis, C. diff colitis, recurrent UTIs | Sepsis, C. diff colitis, recurrent UTIs | No | Sepsis due to strep bacteremia |
| Death-censored graft loss | No | No | No | No | No | No | Yes, pancreas only | Yes | No | No |
| Death (cause) | Yes (COVID) | No | Yes (PEA arrest) | No | No | Yes (malignancy | No | No | Yes (unknown) | Yes (sepsis) |