Jain Ashokkumar B, Marcos Amadeo, Pokharna Renu, Shapiro Ron, Fontes Paulo A, Marsh Wallace, Mohanka Ravi, Fung John J
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Transplantation. 2005 Dec 27;80(12):1692-8. doi: 10.1097/01.tp.0000185570.41571.df.
Occurrence of posttransplant lymphoproliferative disorder (PTLD) after transplantation is known. Drastic reduction or withdrawal of immunosuppression with anti-viral therapy for Ebstein-Barr virus (EBV) is the primary treatment for all PTLD. Many PTLD are B cell in origin have CD20 antigen on the cell surface. Rituximab is a chimeric anti CD20 antibody, which has been used to treat PTLD with variable success. This study aims to report long-term experience with rituximab for PTLD from a single center.
Seventeen patients (13 male, 4 female, mean age 51.2 years) received rituximab to treat PTLD. Five patients received rituximab with drastic reduction in immunosuppression (primary). Nine patients received rituximab after failure of primary therapy (rescue) and three patients received it after resolution of PTLD (prophylactic). Mean follow-up period was 60 months.
Overall 1-, 3-, and 5-year patient survivals were 64.7%, 47.1% and 35.3%, respectively. In the primary group, three patients had complete and one had partial response; however, only two (40%) patients are currently alive. In the rescue group, none of the patients had a complete response, four patients had partial response, and only two (22%) patients are currently alive. In the prophylactic group, two patients died at 28 and 41 months due to recurrence and graft failure, respectively.
Sixty percent (3 of 5) of patients who received rituximab as primary therapy had complete resolution, and 44% (4 of 9) of patients who received it as rescue therapy had partial response. Overall 5-year patient survival was a disappointing 35%.
移植后淋巴组织增生性疾病（PTLD）在移植后较为常见。采用抗病毒疗法大幅减少或停用免疫抑制剂治疗爱泼斯坦-巴尔病毒（EBV）是所有PTLD的主要治疗方法。许多PTLD起源于B细胞，细胞表面有CD20抗原。利妥昔单抗是一种嵌合抗CD20抗体，已用于治疗PTLD，但疗效不一。本研究旨在报告单中心使用利妥昔单抗治疗PTLD的长期经验。
17例患者（13例男性，4例女性，平均年龄51.2岁）接受利妥昔单抗治疗PTLD。5例患者在大幅减少免疫抑制剂用量的情况下接受利妥昔单抗治疗（一线治疗）。9例患者在一线治疗失败后接受利妥昔单抗治疗（挽救治疗），3例患者在PTLD缓解后接受利妥昔单抗治疗（预防性治疗）。平均随访期为60个月。
总体1年、3年和5年患者生存率分别为64.7%、47.1%和%35.3。在一线治疗组，3例患者完全缓解，1例部分缓解；然而，目前只有2例（40%）患者存活。在挽救治疗组，没有患者完全缓解，4例患者部分缓解，目前只有2例（22%）患者存活。在预防性治疗组，2例患者分别在28个月和41个月时因复发和移植物衰竭死亡。
接受利妥昔单抗一线治疗的患者中有60%（5例中的3例）完全缓解，接受挽救治疗的患者中有44%（9例中的4例）部分缓解。总体5年患者生存率低至35%，令人失望。
