Lee Jin-Joo, Lam Masha S H, Rosenberg Amy
College of Pharmacy, University of Florida, Gainesville, FL, USA.
Ann Pharmacother. 2007 Oct;41(10):1648-59. doi: 10.1345/aph.1K175. Epub 2007 Sep 11.
To evaluate the role of chemotherapy and/or rituximab for treatment of posttransplant lymphoproliferative disorder (PTLD) in solid organ transplantation.
A MEDLINE search (1966-May 2007) was conducted using the key words posttransplant lymphoproliferative disorder, solid organ transplantation, chemotherapy, and rituximab. References of relevant articles and abstracts from recent hematology, oncology, and transplantation scientific meetings (2004-May 2007) were also reviewed.
Prospective and retrospective studies identified from the data sources were evaluated, and all information deemed relevant was included for this review.
Overall response rates ranged from 53% to 68%, 25% to 83%, and 74% to 100% for rituximab monotherapy, chemotherapy, and chemotherapy plus rituximab, respectively. Positive response to treatment was influenced by prognostic factors, including presence of Epstein-Barr virus in tumor cells, normal lactate dehydrogenase levels, good performance status, early disease onset after transplantation, and early disease stages. These factors in study patients likely contribute to the variability in response rates seen between treatment options. Severe adverse effects, ranging from grade 3 neutropenia to infection resulting in death, occurred more frequently in patients receiving chemotherapy than in patients receiving only rituximab.
Although reduction in immunosuppressive medications remains the first-line therapy for PTLD treatment, many cases do not respond to this treatment alone, especially monomorphic or more aggressive cases of lymphoma. Therefore, it is reasonable to begin active treatment including rituximab and/or chemotherapy initially, along with reduction in immunosuppression in many cases. Further prospective, comparative studies are urgently needed to confirm the efficacy of these treatment strategies as well as to clarify which subset of patients may benefit most from them.
评估化疗和/或利妥昔单抗在实体器官移植后淋巴细胞增殖性疾病（PTLD）治疗中的作用。
利用关键词“移植后淋巴细胞增殖性疾病”“实体器官移植”“化疗”和“利妥昔单抗”进行了MEDLINE检索（1966年 - 2007年5月）。还查阅了近期血液学、肿瘤学和移植科学会议（2004年 - 2007年5月）相关文章的参考文献和摘要。
对从数据来源中确定的前瞻性和回顾性研究进行评估，所有被认为相关的信息都纳入本综述。
利妥昔单抗单药治疗、化疗以及化疗加利妥昔单抗的总体缓解率分别为53%至68%、25%至83%和74%至100%。对治疗的阳性反应受预后因素影响，包括肿瘤细胞中是否存在爱泼斯坦 - 巴尔病毒、乳酸脱氢酶水平正常、身体状况良好、移植后疾病发病早以及疾病分期早。研究患者中的这些因素可能导致不同治疗方案之间缓解率存在差异。严重不良反应，从3级中性粒细胞减少到导致死亡的感染，在接受化疗的患者中比仅接受利妥昔单抗的患者更频繁发生。
尽管减少免疫抑制药物仍然是PTLD治疗的一线疗法，但许多病例仅靠这种治疗无反应，尤其是单形性或侵袭性更强的淋巴瘤病例。因此，在许多情况下，一开始就进行包括利妥昔单抗和/或化疗在内的积极治疗，并同时减少免疫抑制是合理的。迫切需要进一步的前瞻性、比较性研究来证实这些治疗策略的疗效，并阐明哪些患者亚组可能从这些策略中获益最多。
