摘要
目的:探讨异基因造血干细胞移植(Allo-HSCT)后淋巴增殖性疾病(PTLD)的诊治及预后。方法:回顾性分析755例接受Allo-HSCT患者的PTLD发生情况。结果:755例患者中共计11例(1.46%)诊断为PTLD,其中含抗胸腺细胞球蛋白(ATG)与不含ATG方案组PTLD发生率分别为2.5%和0(P<0.01),脐血移植组、外周血干细胞移植组和外周血干细胞联合骨髓移植组PTLD发生率分别为5.2%、0.8%和1.1%(P<0.01)。11例PTLD患者中,8例检测血清EBV阳性;临床诊断2例,多形性PTLD 1例,单形性PTLD 8例,所有病理组织均检测到EBER阳性;诊断后接受停免疫抑制剂、利妥昔单抗、联合化疗治疗,5例存活,6例死亡。结论:Allo-HSCT后PTLD发生率1.46%,使用含ATG预处理方案和脐带血移植是PTLD的高危因素,EBV监测在PTLD早期发现上有重要意义,病理上以单形性PTLD为主,减停免疫抑制剂、利妥昔单抗联合化疗是治疗PTLD的有效方法。
Objective：To explore the diagnosis,treatment and prognosis of post-transplantation lymphoproliferative disorders（PTLD）after allogeneic hematopoietic stem cell transplantation（Allo-HSCT）.Method：We conducted a retrospective analysis to study the incidence of PTLD in 755 patients received Allo-HSCT.Result：Eleven of755 patients（1.46%）were diagnosed with PTLD.The incidence of PTLD was 2.5% and 0 in ATG group and non-ATG group（P〈0.01）.The incidence of PTLD was 5.2%,0.8% and 1.1% in cord blood transplantation group,peripheral blood stem cell transplantation group and peripheral blood stem cell combined bone marrow transplantation group,respectively（P〈0.01）.EBV was detected positive in 8 patients.Among them,two patients were clinically diagnosed as PTLD.Nine cases were pathologically diagnosed as PTLD,1 case was polymorphic PTLD and 8 cases were monomorphic PTLD.All the tissues were positive for EBER.All the patients received the withdrawal of immunosuppression,rituximab or combined chemotherapy.During the follow-up,5 cases survived and 6 cases died.Conclusion：The incidence of PTLD after Allo-HSCT was 1.46%in our center.Risk factors include the administration of ATG and cord blood transplantation.Monitoring of EBV-DNA levels is important for early diagnosis of PTLD.The monomorphic PTLD is predominant in pathologically diagnosed PTLD.Withdrawal of immunosuppression,rituximab and combination chemotherapy are effective strategy for the treatment of PTLD.
作者
章忠明
李桥川
刘练金
罗琳
施玲玲
刘容容
赖永榕
ZHANG Zhongming;LI Qiaochuan;LIULianjin;LUO Lin;SHI Lingling;LIU Rongrong;LAI Yongrong(Department of Hematology, the First Affiliated Hospital of Guangxi Medial University, Nanning, 530021, China)
出处
《临床血液学杂志》
CAS
2018年第2期193-196,共4页
Journal of Clinical Hematology
关键词
异基因造血干细胞移植
移植后淋巴增殖性疾病
利妥昔单抗
allogeneic hematopoietic stem cell transplantation^post-transplantation lymphoproliferative disor-der
rituximab
