Jenkins D, DiFrancesco L, Chaudhry A, Morris D, Glück S, Jones A, Woodman R, Brown C B, Russell J, Stewart D A
Department of Medicine, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta, Canada.
Bone Marrow Transplant. 2002 Sep;30(5):321-6. doi: 10.1038/sj.bmt.1703603.
We report three cases of post-transplant lymphoproliferative disorder (PTLD) in the context of autologous stem cell transplantation (ASCT) for multiple myeloma (MM) and non-Hodgkin's lymphoma. The first two cases received ASCT for MM, one with a CD34-selected autograft and the other with an unmanipulated autograft. Both these cases of PTLD achieved a complete response following treatment with IVIG, gancyclovir, solumedrol and interferon (IFN). The third case received ASCT with an unmanipulated autograft for relapsed angioimmunoblastic lymphoma. He also achieved a complete response but only after rituximab was added to IVIG, gancyclovir, solumedrol and IFN. None of these patients experienced a relapse of their PTLD with follow-up ranging from 1.5 to 5 years. These cases highlight the importance of considering PTLD in the differential diagnosis of lymphadenopathy and fever post ASCT. They also demonstrate the possibility of durable complete remission of post-ASCT PTLD following antiviral and immune modulating therapy.
我们报告了3例在多发性骨髓瘤（MM）和非霍奇金淋巴瘤自体干细胞移植（ASCT）背景下发生的移植后淋巴细胞增生性疾病（PTLD）。前两例因MM接受ASCT，一例采用CD34选择的自体移植，另一例采用未处理的自体移植。这两例PTLD患者经静脉注射免疫球蛋白（IVIG）、更昔洛韦、甲泼尼龙和干扰素（IFN）治疗后均获得完全缓解。第三例因复发的血管免疫母细胞性淋巴瘤接受未处理的自体移植进行ASCT。他也获得了完全缓解，但仅在IVIG、更昔洛韦、甲泼尼龙和IFN基础上加用利妥昔单抗后才实现。这些患者在1.5至5年的随访中均未出现PTLD复发。这些病例突出了在ASCT后淋巴结病和发热的鉴别诊断中考虑PTLD的重要性。它们还证明了抗病毒和免疫调节治疗后ASCT后PTLD实现持久完全缓解的可能性。
