切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 307 -312. doi: 10.3877/cma.j.issn.1674-3903.2021.05.011

综述

移植后淋巴增殖性疾病研究进展
陈奥1, 练巧燕1, 张建恒1, 徐鑫1, 韦兵1, 蔡宇航1, 王春燕1, 谭获1, 何建行1, 巨春蓉1,()   
  1. 1. 510012 广州医科大学附属第一医院移植科 广州呼吸健康研究院
  • 收稿日期:2021-04-15 出版日期:2021-10-25
  • 通信作者: 巨春蓉
  • 基金资助:
    呼吸疾病国家重点实验室青年自主课题(SKLRD-QN-201710); 2019年度广州呼吸健康研究院/广医一院临床研究中心临床自主探索项目(2019GIRHZ04)

Progress on post transplant lymphoproliferative disorder

Ao Chen1, Qiaoyan Lian1, Jianheng Zhang1, Xin Xu1, Bing Wei1, Yuhang Cai1, Chunyan Wang1, Huo Tan1, Jianxing He1, Chunrong Ju1,()   

  1. 1. Department of Transplantation, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510012, China
  • Received:2021-04-15 Published:2021-10-25
  • Corresponding author: Chunrong Ju
引用本文:

陈奥, 练巧燕, 张建恒, 徐鑫, 韦兵, 蔡宇航, 王春燕, 谭获, 何建行, 巨春蓉. 移植后淋巴增殖性疾病研究进展[J]. 中华移植杂志(电子版), 2021, 15(05): 307-312.

Ao Chen, Qiaoyan Lian, Jianheng Zhang, Xin Xu, Bing Wei, Yuhang Cai, Chunyan Wang, Huo Tan, Jianxing He, Chunrong Ju. Progress on post transplant lymphoproliferative disorder[J]. Chinese Journal of Transplantation(Electronic Edition), 2021, 15(05): 307-312.

移植后淋巴增殖性疾病(PTLD)是实体器官移植(SOT)术后最严重的并发症之一。PTLD严重影响移植受者生存时间,其发病与EB病毒(EBV)感染和机体免疫功能受抑制等相关,组织病理学是其诊断金标准。目前治疗方案包括免疫抑制剂减量、利妥昔单抗、EBV特异性细胞毒性T细胞输注及化疗等,但SOT术后并发PTLD受者总体预后仍较差。本文主要对近年来SOT术后并发PTLD研究进展作一综述,以期为临床更好地诊断SOT术后PTLD发生及早期干预提供理论及实践指导。

Post-transplant lymphoproliferative disorder (PTLD) is one of the most serious complications after solid organ transplantation (SOT). PTLD seriously affects the survival time of transplant recipients, the incidence of PTLD is related to Epstein-Barr virus (EBV) infection and suppression of immune function, and histopathology is the gold standard for its diagnosis. Current treatment options include dose-reduction of immunosuppressant, rituximab, EBV specific cytotoxic T lymphocyte infusion and chemotherapy, and so on, but the overall prognosis of PTLD patients is still poor. This review mainly summarizes the research progress of PTLD after SOT in recent years, in order to diagnose the occurrence of PTLD after SOT better, and provide theoretical and practical guidance for early intervention.

表1 移植后淋巴增殖性疾病分型及相关特征[11,18]
1
Heslop HE. How I treat EBV lymphoproliferation[J]. Blood, 2009, 114(19): 4002-4008.
2
Martinez OM, Krams SM. The immune response to Epstein Barr virus and implications for posttransplant lymphoproliferative disorder[J]. Transplantation, 2017, 101(9): 2009-2016.
3
Abbas F, El Kossi M, Shaheen IS, et al. Post-transplantation lymphoproliferative disorders: Current concepts and future therapeutic approaches[J]. World J Transplant, 2020, 10(2): 29-46.
4
Krams SM, Martinez OM. Epstein-Barr virus, rapamycin, and host immune responses[J]. Curr Opin Organ Transplant, 2008, 13(6): 563-568.
5
Vereide DT, Sugden B. Lymphomas differ in their dependence on Epstein-Barr virus[J]. Blood, 2011, 117(6): 1977-1985.
6
Burns DM, Tierney R, Shannon-Lowe C, et al. Memory B-cell reconstitution following allogeneic hematopoietic stem cell transplantation is an EBV-associated transformation event[J]. Blood, 2015, 126(25): 2665-2675.
7
Ferreiro JF, Morscio J, Dierickx D, et al. EBV-positive and EBV-negative posttransplant diffuse large B cell lymphomas have distinct genomic and transcriptomic features[J]. Am J Transplant, 2016, 16(2): 414-425.
8
Courville EL, Yohe S, Chou D, et al. EBV-negative monomorphic B-cell post-transplant lymphoproliferative disorders are pathologically distinct from EBV-positive cases and frequently contain TP53 mutations[J]. Mod Pathol, 2016, 29(10): 1200-1211.
9
Dierickx D, Tousseyn T, Gheysens O. How I treat posttransplant lymphoproliferative disorders[J]. Blood, 2015, 126(20): 2274-2283.
10
Weisenburger DD, Gross TG. Post-transplant lymphoproliferative disorder: a heterogeneous conundrum[J]. Br J Haematol, 2017, 179(5): 854-856.
11
Doak PB, Montgomerie JZ, North JD, et al. Reticulum cell sarcoma after renal homotransplantation and azathioprine and prednisone therapy[J].Br Med J, 1968, 4(5633): 746-748.
12
Opelz G, Döhler B. Lymphomas after solid organ transplantation: a collaborative transplant study report[J]. Am J Transplant, 2004, 4(2): 222-230.
13
Dierickx D, Tousseyn T, Sagaert X, et al. Single-center analysis of biopsy-confirmed posttransplant lymphoproliferative disorder: incidence, clinicopathological characteristics and prognostic factors[J]. Leuk Lymphoma, 2013, 54(11): 2433-2440.
14
Zaffiri L, Long A, Neely ML, et al. Incidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry[J]. J Heart Lung Transplant, 2020, 39(10): 1089-1099.
15
Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation[J]. Crit Rev Oncol Hematol, 2005, 56(1): 155-167.
16
Cherikh WS, Kauffman HM, Mcbride MA, et al. Association of the type of induction immunosuppression with posttransplant lymphoproliferative disorder, graft survival, and patient survival after primary kidney transplantation[J]. Transplantation, 2003, 76(9): 1289-1293.
17
Opelz G, Daniel V, Naujokat C, et al. Epidemiology of pretransplant EBV and CMV serostatus in relation to posttransplant non-Hodgkin lymphoma[J]. Transplantation, 2009, 88(8): 962-967.
18
Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20): 2375-2390.
19
Sandlund JT, Guillerman RP, Perkins SL, et al. International pediatric non-hodgkin lymphoma response criteria[J]. J Clin Oncol, 2015, 33(18): 2106-2111.
20
Panagiotidis E, Quigley AM, Pencharz D, et al. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis of post-transplant lymphoproliferative disorder[J]. Leuk Lymphoma, 2014, 55(3): 515-519.
21
Allen UD, Preiksaitis JK. Post-transplant lymphoproliferative disorders, Epstein-Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9): e13652.
22
Romero S, Montoro J, Guinot M, et al. Post-transplant lymphoproliferative disorders after solid organ and hematopoietic stem cell transplantation[J]. Leuk Lymphoma, 2019, 60(1): 142-150.
23
刘占祥. 移植后淋巴细胞增殖性疾病诊断进展与治疗规范[J]. 白血病·淋巴瘤2017, 26(8): 502-505.
24
Destefano CB, Desai SH, Shenoy AG, et al. Management of post-transplant lymphoproliferative disorders[J]. Br J Haematol, 2018, 182(3): 330-343.
25
San-Juan R, Manuel O, Hirsch HH, et al. Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey[J]. Clin Microbiol Infect, 2015, 21(6): 601-604.
26
Reshef R, Vardhanabhuti S, Luskin MR, et al. Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder (★) [J]. Am J Transplant, 2011, 11(2): 336-347.
27
Parker A, Bowles K, Bradley JA, et al. Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients-BCSH and BTS Guidelines[J]. Br J Haematol, 2010, 149(5): 693-705.
28
Dierickx D, Habermann TM. Post-transplantation lymphoproliferative disorders in adults[J]. N Engl J Med, 2018, 378(6): 549-562.
29
Doubrovina E, Oflaz-Sozmen B, Prockop SE, et al. Adoptive immunotherapy with unselected or EBV-specific T cells for biopsy-proven EBV+ lymphomas after allogeneic hematopoietic cell transplantation[J]. Blood, 2012, 119(11): 2644-2656.
30
Heslop HE, Slobod KS, Pule MA, et al. Long-term outcome of EBV-specific T-cell infusions to prevent or treat EBV-related lymphoproliferative disease in transplant recipients[J]. Blood, 2010, 115(5): 925-935.
31
Prockop SE, Vatsayan A. Epstein-Barr virus lymphoproliferative disease after solid organ transplantation[J]. Cytotherapy, 2017, 19(11): 1270-1283.
32
Haque T, Wilkie GM, Jones MM, et al. Allogeneic cytotoxic T-cell therapy for EBV-positive posttransplantation lymphoproliferative disease: results of a phase 2 multicenter clinical trial[J]. Blood, 2007, 110(4): 1123-1131.
33
Chiou FK, Beath SV, Wilkie GM, et al. Cytotoxic T-lymphocyte therapy for post-transplant lymphoproliferative disorder after solid organ transplantation in children[J]. Pediatr Transplant, 2018, 22(2): e13133.
34
Dharnidharka VR, Mohanakumar T. New approaches to treating B-cell cancers induced by Epstein-Barr virus[J]. N Engl J Med, 2015, 372(6): 569-571.
35
Choquet S, Leblond V, Herbrecht R, et al. Efficacy and safety of rituximab in B-cell post-transplantation lymphoproliferative disorders: results of a prospective multicenter phase 2 study[J]. Blood, 2006, 107(8): 3053-3057.
36
Choquet S, Oertel S, Leblond V, et al. Rituximab in the management of post-transplantation lymphoproliferative disorder after solid organ transplantation: proceed with caution[J]. Ann Hematol, 2007, 86(8): 599-607.
37
Choquet S, Trappe R, Leblond V, et al. CHOP-21 for the treatment of post-transplant lymphoproliferative disorders (PTLD) following solid organ transplantation[J]. Haematologica, 2007, 92(2): 273-274.
38
Trappe RU, Dierickx D, Zimmermann H, et al. Response to rituximab induction is a predictive marker in B-Cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase Ⅱtrial[J]. J Clin Oncol, 2017, 35(5): 536-543.
39
Trappe R, Oertel S, Leblond V, et al. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder (PTLD): the prospective international multicentre phase 2 PTLD-1 trial[J]. Lancet Oncol, 2012, 13(2): 196-206.
40
Odumade OA, Hogquist KA, Balfour HJ. Progress and problems in understanding and managing primary Epstein-Barr virus infections[J]. Clin Microbiol Rev, 2011, 24(1): 193-209.
41
Aldabbagh MA, Gitman MR, Kumar D, et al. The role of antiviral prophylaxis for the prevention of Epstein-Barr virus-associated posttransplant lymphoproliferative disease in solid organ transplant recipients: a systematic review[J]. Am J Transplant, 2017, 17(3): 770-781.
42
Perrine SP, Hermine O, Small T, et al. A phase 1/2 trial of arginine butyrate and ganciclovir in patients with Epstein-Barr virus-associated lymphoid malignancies[J]. Blood, 2007, 109(6): 2571-2578.
43
Shyamasundar S, Dheen ST, Bay BH. Histone modifications as molecular targets in nasopharyngeal cancer[J]. Curr Med Chem, 2016, 23(2): 186-197.
44
Cavaliere R, Petroni G, Lopes MB, et al. Primary central nervous system post-transplantation lymphoproliferative disorder: an international primary central nervous system lymphoma collaborative group report[J]. Cancer, 2010, 116(4): 863-870.
45
Evens AM, Choquet S, Kroll-Desrosiers AR, et al. Primary CNS posttransplant lymphoproliferative disease (PTLD): an international report of 84 cases in the modern era[J]. Am J Transplant, 2013, 13(6): 1512-1522.
46
Wu M, Sun J, Zhang Y, et al. Intrathecal rituximab for EBV-associated post-transplant lymphoproliferative disorder with central nervous system involvement unresponsive to intravenous rituximab-based treatments: a prospective study[J]. Bone Marrow Transplant, 2016, 51(3): 456-458.
47
Läubli H, Tzankov A, Juskevicius D, et al. Lenalidomide monotherapy leads to a complete remission in refractory B-cell post-transplant lymphoproliferative disorder[J]. Leuk Lymphoma, 2016, 57(4): 945-948.
[1] 肖梦瑶, 辛小娟. 成人EB病毒相关噬血细胞综合征的危险因素[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(02): 73-81.
[2] 凌炜焱, 丁俊琪, 田芝奥, 姚建华. 48例成人慢性活动性EB病毒感染的临床特征和外周血淋巴细胞免疫表型[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(05): 424-428.
[3] 解承娟, 李满桂, 任啟霞, 唐宁, 刘成花, 李生梅, 马慧英. EB病毒感染患儿凝血和免疫功能相关指标分析及临床意义[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(02): 162-166.
[4] 中国康复医学会器官移植康复专业委员会. 成人实体器官移植后糖尿病管理专家共识[J]. 中华移植杂志(电子版), 2023, 17(04): 205-220.
[5] 国家传染病医学中心, 中华医学会器官移植学分会, 中国康复医学会器官移植康复专业委员会, 中国器官移植发展基金会器官移植受者健康管理专项基金. 实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版)[J]. 中华移植杂志(电子版), 2023, 17(02): 65-81.
[6] 陈琦, 郭嘉瑜, 陈忠宝, 马枭雄, 王天宇, 邹寄林, 张龙, 蔡治涛, 邱涛, 周江桥. 心肾联合移植三例[J]. 中华移植杂志(电子版), 2023, 17(02): 124-127.
[7] 中国器官移植发展基金会器官移植受者健康管理专家委员会. 器官移植受者新型冠状病毒感染防治策略与健康管理中国专家指导意见(第一版)[J]. 中华移植杂志(电子版), 2023, 17(01): 1-12.
[8] 施丹, 高志刚. 儿童肝移植术后淋巴增殖性疾病研究进展[J]. 中华移植杂志(电子版), 2022, 16(03): 174-178.
[9] 中国医师协会器官移植医师分会, 中华医学会器官移植学分会. 中国实体器官移植手术部位感染管理专家共识(2022版)[J]. 中华移植杂志(电子版), 2022, 16(03): 129-139.
[10] 艾亮, 成柯, 张盛. 再次肾移植术后并发移植后淋巴增殖性疾病伴结核病一例[J]. 中华移植杂志(电子版), 2022, 16(01): 46-48.
[11] 胡正斌, 周鑫, 熊艳, 范晓礼, 范志鹏, 叶啟发. 实体器官移植后移植物长期存活评估相关生物标志物研究进展[J]. 中华移植杂志(电子版), 2021, 15(04): 244-249.
[12] 严紫嫣, 符芳翔, 苗芸. 实体器官移植术后隐球菌病研究进展[J]. 中华移植杂志(电子版), 2020, 14(04): 263-267.
[13] 刘东岳, 解曼, 孔心涓, 饶伟. 实体器官移植受者移植术后下消化道并发症流行病学及影响因素[J]. 中华移植杂志(电子版), 2019, 13(01): 71-74.
[14] 贾雁琳, 郝彦琴. EB病毒感染机制及临床研究进展[J]. 中华临床医师杂志(电子版), 2019, 13(08): 624-626.
[15] 张扬, 邓芳, 陈少华, 陈兆武, 戴春阳, 李明. 单个核细胞EB病毒DNA载量在鼻咽癌患者中的变化初探[J]. 中华临床实验室管理电子杂志, 2019, 07(01): 22-25.
阅读次数
全文


摘要