Abstract:

Objective To show the demographic data and to explore the characteristics of post-transplantlymphoproliferative 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 were11（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 dosagereduction，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 theSOT recipients. ATG administration and previous GVHD are survival.

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摘要：

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。

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