Clinical Analysis of Post-Transplant Lymphoproliferative Disorder after Hematopoietic Stem Cell Transplantation in Severe Aplastic Anemia Patients.
10.19746/j.cnki.issn.1009-2137.2022.04.040
- Author:
Hong-Min YAN
1
;
Xiao-Li ZHENG
1
;
Ling ZHU
1
;
Li DING
1
;
Dong-Mei HAN
1
;
Jing LIU
1
;
Mei XUE
1
;
Sheng LI
1
;
Heng-Xiang WANG
2
Author Information
1. Department of Hematology, The General Hospital of Air Force, Beijing 100142, China.
2. Department of Hematology, The General Hospital of Air Force, Beijing 100142, China,E-mail: hengxiangwang123@aliyun.com.cn.
- Publication Type:Journal Article
- Keywords:
EB virus;
Rituximab;
hematopoietic stem cell transplantation;
posttransplant lymphoproliferative disorder;
severe aplastic anemia
- MeSH:
Anemia, Aplastic/therapy*;
Child;
Epstein-Barr Virus Infections/complications*;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Humans;
Lymphoproliferative Disorders/therapy*;
Retrospective Studies;
Rituximab/therapeutic use*
- From:
Journal of Experimental Hematology
2022;30(4):1224-1229
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To analyze the clinical characteristics of SAA patients with post-transplantation lymphoproliferative disease (PTLD) after allogeneic hematopoietic stem cell transplantation, and to improve diagnosis and treatment of PTLD.
METHODS:The clinical data of 192 patients with SAA patients who underwent HSCT in a single center from September 2010 to September 2017 were analyzed retrospectively. All patients were received antithymocyte globulin（ATG） conditioning regimen and mesenchymal stem cell(MSC) infusion.
RESULTS:Among 192 cases, PTLD occurred in 14 cases, the incidence was 7.29％， 9 of them were diagnosed by pathology， and 5 were diagnosed clinically. EBV infection occurred with a median time of 72（35-168） days, Viral load higher than 1×104 copies/ml occured in all PTLD patients. The incidence of probable PTLD in patients ≤12 years old and ＞12 years old was 11.11%, 2.38%, respectively (P<0.01）. Univariate and multivariate analysis that the EBV infection, patients age≤12 years old, HLA-mismatch in URD-HSCT, grade II to IV aGVHD were the independent risk factors for PTLD. All PTLD patients were treated with rituximab(RTX) when EBV-DNA load higher than 1×104 copies/ml, or reducted the use of immunosuppression(RIS), patients with poor therapeutic effect were treated combined with EBV-specific CTLs(EBV-CTL) and chemotherapy. All patients were treated effectively, and the total effective rate was 100％. The median follow-up time was 65(62-115) months, and the overall survival rate was 92.85%. One patients died of cerebral hemorrhage, 7 months after PTLD curred.
CONCLUSION:The incidence of PTLD after HSCT with SAA who used ATG and MSC in conditioning regimen closely relates to EBV infection, age of patients≤12 years, HLA-mismatch in URD-HSCT, grade II to IV GVHD. Rituximab combined with RIS may reduce the incidence of PTLD, combined EBV-CTL and chemotherapy may be the useful and most important treatment for PTLD.
