常规方案联合利妥昔单抗治疗单倍体相合HSCT后淋巴细胞增生性疾病三例

Efficacy of rituximab-containing regimens on post-transplantation lymphoproliferative disorder following haploidentical hematopoietic stem cell transplantation： a report of 3 cases

目的观察含利妥昔单抗的方案治疗单倍体相合造血干细胞移植（HSCT）后淋巴细胞增生性疾病（PTLD）的疗效。方法回顾性分析3例单倍体相合HSCT后PTLD患者的临床资料。3例分别于移植后57-164d发生PTLD，临床表现为发热、浅表淋巴结肿大。经淋巴结组织病理检查确诊为PTLD，均为B淋巴细胞来源，EB病毒DNA阳性。采用减量或者停用免疫抑制剂，抗病毒治疗，应用利妥昔单抗（1例联合化疗）治疗。利妥昔单抗的剂量为375mg／m2，每周1次，共用4次。结果治疗后3例的淋巴结均明显缩小，患者的体温恢复正常，病情缓解。结论PTLD是HSCT尤其是单倍体相合HScT后的严重并发症，含利妥昔单抗的治疗方案对于PTLD的治疗效果较好。

Objective To evaluate the efficacy of rituximab-containing regimens on post- transplantation lymphoproliferative disorder （PTLD） following haploidentical hematopoietic stern cell transplantation （HSCT）. Methods The clinical data of 3 eases of PTLD after haploidentical HSCT were analyzed retrospectively. Time to development of PTLD ranged from 57 to 164 days after HSCT. The main symptoms included {ever, superficial lymph node enlargement. Epstein-Parr virus （EBV）- positive B-cell PTLD was ,diagnosed by biopsy of lymph node. Management of 3 patients consisted of withdraw of immunosuppressive treatment, anti-viral therapy, rituximab （375 mg/m2 , per week for four weeks） monotherapy or chemotherapy plus rituximab. Results All the patients had complete remission after treatment. Conclusion PTLD is a serious complication of HSCT especially haploidentical HSCT. Rituximab-containing regimens are potentially effective, well-tolerated with mild toxicity and improve the prognosis of PTLD following haploidentical HSCT.