国内报道移植后淋巴增殖性疾病的总结分析

Post-transplant lymphoproliferative disorders:a summary analysis of reported cases in China

目的总结我国移植后淋巴增殖性疾病(PTLD)的资料,并对其特点进行分析。方法通过中国知网(CNKI)、维普期刊数据库和万方资源数据库联合检索,以"移植"且"肿瘤"和"移植后淋巴(组织/细胞)增殖/增生疾病"或"PTLD"为主题词进行检索,对其中21篇文献的46例PTLD病例进行统计分析。结果造血干细胞移植(HSCT)受者27例和实体器官移植(SOT)受者19例纳入分析:(1)HSCT组发病时间为移植后3个月,明显早于SOT患者(12个月,P<0.05);(2)HSCT组中使用抗胸腺淋巴细胞免疫球蛋白(ATG)的比例明显高于SOT组(63%比5%,P<0.01);(3)HSCT组中有11例(41%)在PTLD发病前出现移植物抗宿主病(GVHD),而SOT组则无GVHD发生(P<0.01);(4)Kaplan-Meier检验显示HSCT组较SOT组病情进展迅速、凶险,存活率低(P<0.05)。1年总体生存率HSCT组为30%,SOT组为60%;(5)将年龄、移植种类(HSCT/SOT)、移植至PTLD时间、PTLD分型、临床分期、PTLD诊断时EB病毒的感染状态、ATG使用、GVHD、免疫抑制剂(IS)减量、化疗、外科手术以及利妥昔单抗使用等12个因素纳入COX风险分析模型,提示对于PTLD患者生存的不利因素为ATG使用和GVHD发生。结论PTLD多于移植术后早期发生,进展迅猛、预后差;HSCT患者较SOT发生PTLD后生存率更低;ATG使用和发生GVHD是影响患者生存的的危险因素。

Objective To show the demographic data and to explore the characteristics of post-transplant lymphoproliferative disorders(PTLD)patients in China. Methods All the data were selected for reported PTLD cases from the China Knowledge Resource Integrated Database,VIP Chinese Journal Database and Wanfang database. Key words used for searching were PTLD,malignancies,and transplantation(Tx). 46 cases from 21 articles were analyzed. Results 27 hematopoietic stem cell transplant(HSCT)recipients and 19 solid organ transplant (SOT)recipients were reported in the Chinese literatures,who developed PTLD.(1)PTLD in HSCT recipients was diagnosed earlier than the SOT recipients(3 months vs. 12 months,P<0.05).(2)Antithymocyteglobulin(ATG) was administrated to more patients in HSCT group than that in SOT group(63%vs. 5%,P<0.01).(3)There were 11(41%)HSCT patients who experienced GVHD,while there was no GVHD occurred in SOT patients(P<0.01). (4)Kaplan-Meier test showed HSCT recipients experienced worse outcomes than the SOT group(P<0.05). 1-year overall survival for HSCT recipients with PTLD was 30%while 60%for SOT patients.(5)COX proportional hazards analysis was used with 12 factors that may influence survival:age,type of Tx,time from Tx to PTLD diagnosis,PTLD classification,clinical stage,EBV infection at diagnosis of PTLD,ATG,GVHD,immunosuppressive dosage reduction,chemo-therapy,surgery and rituximab. And it suggested that the two factors that had the greatest negative effect on survival were ATG administration and previous GVHD. Conclusions These analyses indicate that PTLD occur early post Tx with aggressive course and adverse outcome. HSCT patients experience worse outcomes than the SOT recipients. ATG administration and previous GVHD are survival.