Trappe Ralf, Riess Hanno, Babel Nina, Hummel Manfred, Lehmkuhl Hans, Jonas Sven, Anagnostopoulos Ioannis, Papp-Vary Matthias, Reinke Petra, Hetzer Roland, Dörken Bernd, Oertel Stephan
1Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Transplantation. 2007 Apr 15;83(7):912-8. doi: 10.1097/01.tp.0000258647.50947.78.
Single-agent rituximab has demonstrated encouraging efficacy and tolerability in posttransplant lymphoproliferative disorders (PTLDs) failing to respond to immunosuppression reduction (IR). This retrospective analysis was undertaken to determine the efficacy and safety of salvage therapy in recipients of solid organ transplants with progression of PTLD after rituximab first-line therapy.
Eleven patients who had received IR and single-agent rituximab were analyzed. Of these, 10 had received CHOP salvage chemotherapy. One patient with limited disease received tumor irradiation and further IR. Most patients (73%) had late PTLD (median onset of disease 145 months posttransplant), and most (83%) had monomorphic histology; 36% had EBV-association.
IR and irradiation therapy re-induced complete remission (CR) and allowed long-term disease control in a patient with polymorphic PTLD relapse. CHOP therapy achieved CR in five (50%) and partial remission (PR) in two (20%) patients. Four of five (80%) patients achieving CR remained in CR at a median follow-up of 44.2 months. Of the patients achieving PR, one is currently alive, and the second died from transplant rejection after converting to CR after consolidative chemotherapy. Patients with stable disease (two) and progressive disease (one) have died from PTLD. There was one possible CHOP-associated death (acute cardiac event) and two patients had to be switched to less-toxic monotherapies. Median overall survival was 46.5 months (95% confidence interval: 23.6-49.1 months).
CHOP salvage therapy achieved a favorable overall response rate of 70% in this setting, indicating that PTLD generally remains chemotherapy-sensitive after progression following first-line rituximab.
对于移植后淋巴细胞增殖性疾病（PTLD），单药利妥昔单抗在对免疫抑制降低（IR）无反应的患者中已显示出令人鼓舞的疗效和耐受性。本回顾性分析旨在确定实体器官移植受者在利妥昔单抗一线治疗后PTLD进展时挽救治疗的疗效和安全性。
对11例接受IR和单药利妥昔单抗治疗的患者进行分析。其中，10例接受了CHOP挽救化疗。1例疾病局限的患者接受了肿瘤照射及进一步的IR。大多数患者（73%）为晚期PTLD（疾病中位发病时间为移植后145个月），且大多数（83%）具有单形性组织学特征；36%与EBV相关。
IR和照射治疗使1例多形性PTLD复发患者再次完全缓解（CR）并实现了长期疾病控制。CHOP治疗使5例（50%）患者达到CR，2例（20%）患者达到部分缓解（PR）。达到CR的5例患者中有4例（80%）在中位随访44.2个月时仍处于CR状态。达到PR的患者中，1例目前存活，另1例在巩固化疗后转为CR后死于移植排斥反应。疾病稳定（2例）和疾病进展（1例）的患者死于PTLD。有1例可能与CHOP相关的死亡（急性心脏事件），2例患者不得不改用毒性较小的单一疗法。中位总生存期为46.5个月（95%置信区间：23.6 - 49.1个月）。
在这种情况下，CHOP挽救治疗的总体缓解率达70%，表明PTLD在一线利妥昔单抗治疗进展后通常仍对化疗敏感。
