异基因外周血造血干细胞移植后PTLD的临床分析  

Clinical Characteristics,Treatment and Prognosis of PTLD after allogeneic Hematopoietic Stem Cell Transplantation

作　　者：刘占祥[1] 黄文荣[1] 李猛[1] 谷振阳[1] 朱成英[1] 卢柠[1] 姚盛[1] 王书红[1] 李菲[1] 高晓宁[1] 刘代红[1] 高春记[1] LIU Zhan-Xiang , HUANG Wen-Rong , LI Meng , GU Zhen-Yang , ZHU Cheng-Ying , LU Ning , YAO Sheng, WANG Shu-Hong, LI Fei, GAO Xiao-Ning, LIU Dai-Hong, GAO Chun-Ji(Department of Hematology, Chinese PLA General Hospital, Medical College of Chinese PLA, Beijing 100853, Chin)

机构地区：[1]解放军总医院血液科,解放军医学院,北京100853

出　　处：《中国实验血液学杂志》2018年第2期535-540,共6页Journal of Experimental Hematology

摘　　要：目的:研究异基因外周血造血干细胞移植后淋巴增殖性疾病(PTLD)的临床特点,提高对PTLD的认识和诊疗水平。方法:回顾分析于2014年5月-2017年4月在中国人民解放军总医院接受异基因外周血造血干细胞移植的244例患者(随访时间截止至2017年11月30日),总结异基因外周血造血干细胞移植后PTLD的发病率、危险因素、治疗疗效以及生存情况。结果:244例移植患者中,发生PTLD 22例,发病率为9.02%,其中病理确诊5例,临床诊断17例。22例PTLD患者均伴有EB病毒感染,均为使用ATG的亲缘单倍体相合造血干细胞移植或非亲缘供者造血干细胞移植患者。20例应用了利妥昔单克隆抗体单药或以利妥昔单克隆抗体为基础的联合治疗方案,17例有效,有效率85%。中位随访时间122 d,中位生存时间5(1-22)个月,总生存率50%。结论:异基因外周血造血干细胞移植后PTLD的发病与EB病毒感染关系密切。预处理方案中应用ATG是PTLD发病的高危因素。在无法取得病理诊断的情况下,应积极结合临床和实验室检查给予临床诊断。临床上越来越多地选用利妥昔单克隆抗体治疗PTLD。Objective： To study the clinical characteristics of patients with post-transplantation lymphoproliferative disease （PTLD） after allogeneic peripheral blood hematopoietic stem cell transplantation, and to improve the understanding and diagnosis of PTLD. Methods： The clinical data of 244 patients underwent allogeneic hematopoietic stem cell transplantation in the General Hospital of PLA from May 2014 to April 2017 were analyzed retrospectively. The follow-up time was up to November 30, 2017. The incidence, risk factors, treatment and survival of patients with PTLD were statistically analyzed. Results： Among the 244 cases the PTLD occurred in 22 cases, the incidence rate was 9. 02%, 5 of them were diagnosed by pathology, and 17 were diagnosed clinically. All of them had EB virus infection. They were all ATG user, either underwent related haploidentical hematopoietic stem cell transplantation or unrelated hematopoietic stem cell transplantation, 20 cases were treated with rituximab or rituximab combined with ~/- globulin, glucocorticoid, ERV ＋ CTL, chemotherapy and 17 showed the effective response, with a total effective rate of 85%. The median follow-up time was 122 days, the median survival time was 5 months （1 -22 months） and the total survival rate was 50%. Conclusion： The incidence of PTLD after allogeneic peripheral blood hematopoietic stem cell transplantation closely relates with EB virus infection. The application of ATG in the preconditioning scheme is a high risk factor for the onset of PTLD. In the case of no pathological diagnosis, clinical and laboratory examinations should be actively combined so as to define clinical diagnosis. The riturimab should be used more and more for patients with PTLD.

关 键 词：异基因外周血造血干细胞移植 移植后淋巴增殖性疾病 利妥昔单抗 

分 类 号：R457.7[医药卫生—治疗学] R551.2[医药卫生—临床医学]