免疫球蛋白或抗病毒药物预防巨细胞病毒感染对移植后非霍奇金淋巴瘤的影响：一项多中心回顾性分析

Effect of cytomegalovirus prophylaxis with immunoglobulin or with antiviral drugs on post-transplant non-Hodgkin lymphoma: a multicentre retrospective analysis.

作者信息

Opelz Gerhard, Daniel Volker, Naujokat Cord, Fickenscher Helmut, Döhler Bernd

机构信息

Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.

出版信息

Lancet Oncol. 2007 Mar;8(3):212-8. doi: 10.1016/S1470-2045(07)70040-2.

DOI:10.1016/S1470-2045(07)70040-2

PMID:17329191

Abstract

BACKGROUND

Post-transplant non-Hodgkin lymphoma is a feared complication of immunosuppressive treatment and is associated with high mortality. Most post-transplant lymphomas develop from the uncontrolled proliferation of Epstein-Barr-virus (EBV)-infected B lymphocytes. No reliable methods for the prevention of EBV infection and lymphoma are available. We aimed to elucidate the effect of prophylactic treatment for cytomegalovirus (CMV) infection on the incidence of post-transplant lymphomas.

METHODS

In a multicentre retrospective study, we analysed the incidence of post-transplant non-Hodgkin lymphoma in 44 828 recipients of deceased-donor kidney transplants who were reported to the scientific registry of the Collaborative Transplant Study. Patients had received antiviral drugs (aciclovir or ganciclovir) or anti-CMV immunoglobulin to prevent CMV infection according to the transplant centres' protocols, or no CMV prophylaxis. Standardised incidence ratios (SIR) of lymphoma were calculated and compared by chi(2) analyses

FINDINGS

During the first post-transplantation year, 30 255 patients who did not receive CMV prophylaxis developed lymphomas at SIR 26.4. Lymphoma incidence in 12 470 patients who received antiviral treatment was nearly identical (SIR 24.2, p=0.62) to that in patients who did not receive CMV prophylaxis. However, 2103 patients who received anti-CMV immunoglobulin showed a complete absence of lymphomas in the first after-transplantation year (SIR 0; p=0.012 vs no treatment, p=0.016 vs antivirals). In the subsequent 5 years of follow-up, new cases of lymphoma developed at similar rates in all three groups (p=0.97).

INTERPRETATION

These findings suggest that prophylactic anti-CMV immunoglobulin prevents the development of early post-transplant non-Hodgkin lymphoma in kidney-graft recipients. Prophylactic treatment with antiviral drugs does not reduce the risk of post-transplant lymphoma.

摘要

背景

移植后非霍奇金淋巴瘤是免疫抑制治疗令人担忧的并发症，且与高死亡率相关。大多数移植后淋巴瘤由感染爱泼斯坦-巴尔病毒（EBV）的B淋巴细胞不受控制地增殖发展而来。目前尚无预防EBV感染和淋巴瘤的可靠方法。我们旨在阐明巨细胞病毒（CMV）感染预防性治疗对移植后淋巴瘤发病率的影响。

方法

在一项多中心回顾性研究中，我们分析了向协作移植研究科学登记处报告的44828例已故供体肾移植受者中移植后非霍奇金淋巴瘤的发病率。根据移植中心的方案，患者接受了抗病毒药物（阿昔洛韦或更昔洛韦）或抗CMV免疫球蛋白以预防CMV感染，或未进行CMV预防。计算淋巴瘤的标准化发病率（SIR），并通过卡方分析进行比较。

结果

在移植后的第一年，12470例接受抗病毒治疗的患者淋巴瘤发病率与未接受CMV预防的患者几乎相同（SIR 24.2，p = 0.62）。然而，2103例接受抗CMV免疫球蛋白治疗的患者在移植后的第一年完全没有发生淋巴瘤（SIR 0；与未治疗相比，p = 0.012；与抗病毒药物相比，p = 0.016）。在随后的5年随访中，三组中淋巴瘤新发病例的发生率相似（p = 0.97）。