Unholzer Angela, Starz Hans, Hirschsteiner Oliver, Balda Bernd-Rüdiger
Klinik für Dermatologie und Allergologie, Klinikum Augsburg.
J Dtsch Dermatol Ges. 2005 Jan;3(1):46-51.
Malignant tumors are a frequent complication in the late phase after organ transplantation. Malignant lymphomas are the second most common tumor, exceeded only by cutaneous carcinomas. Compared to the general population, the organ transplant patients have a 30-60 fold increased risk of developing non-Hodgkin's lymphoma. A 55-year-old, hepatitis C-positive man developed an Epstein-Barr virus (EBV)- negative Burkitt lymphoma (BL) first appearing on the gingiva under immunosuppressive therapy nine years after allogenic renal transplantation. He died 37 days after the onset of polychemotherapy. Immediately before his death, meningeal involvement by the BL was diagnosed. BL after organ transplantation is often found at extranodal sites; it involves the central nervous system more frequently than it does in immunocompetent patients. In 70% of BL occurring after organ transplantation, genes or gene products related to EBV can be demonstrated within the tumor cells. The EBV status of the tumor is of important prognostic significance: EBV-positive BL occurring in organ transplant patients usually responds well to reduction or cessation of immunosuppressive therapy; in some cases permanent complete remissions can be achieved even without chemotherapy. In contrast, patients with EBV-negative BL have a very poor prognosis and hardly respond, even to aggressive chemotherapy protocols.
恶性肿瘤是器官移植后期常见的并发症。恶性淋巴瘤是第二常见的肿瘤，仅次于皮肤癌。与普通人群相比，器官移植患者发生非霍奇金淋巴瘤的风险增加30至60倍。一名55岁的丙型肝炎阳性男性，在同种异体肾移植9年后接受免疫抑制治疗期间，牙龈上首次出现了一株爱泼斯坦-巴尔病毒（EBV）阴性的伯基特淋巴瘤（BL）。他在接受多药化疗37天后死亡。就在他去世前，诊断出BL侵犯脑膜。器官移植后的BL常发生于结外部位；与免疫功能正常的患者相比，它更常累及中枢神经系统。在器官移植后发生的BL中，70%的肿瘤细胞内可检测到与EBV相关的基因或基因产物。肿瘤的EBV状态具有重要的预后意义：器官移植患者中出现的EBV阳性BL通常对减少或停止免疫抑制治疗反应良好；在某些情况下，即使不进行化疗也可实现持久的完全缓解。相比之下，EBV阴性BL患者的预后非常差，即使采用积极的化疗方案也几乎没有反应。
