Taj Mary M, Messahel Boo, Mycroft Julie, Pritchard-Jones Kathy, Baker Alistair, Height Susan, Hadzic Nedim, Pinkerton C Ross
Department of Paediatric Oncology, Royal Marsden Hospital, Sutton, Surrey, UK.
Br J Haematol. 2008 Jan;140(2):191-6. doi: 10.1111/j.1365-2141.2007.06896.x.
Childhood post-transplant lymphoproliferative disease (PTLD) is a heterogeneous condition in which treatment varies, from the reduction of immunosuppression to moderately intensive chemotherapy. While low-dose chemotherapy/rituximab has been found to be effective, moderately intensive chemotherapy is required for patients who relapse, have classic non-Hodgkin lymphoma or have fulminant PTLD. Methotrexate (Mtx) is highly effective in lymphomas and crosses the blood-brain barrier. However, there are no data in the literature regarding its safety in post-liver transplant patients. We describe four cases of high-grade lymphomas (three diffuse large B cell and one T-cell lymphoblastic), post-liver transplant, for which chemotherapy including high-dose Mtx (HDMTX) was the treatment of choice. In total, 20 doses of HDMTX (1-5 g/m(2)) were given. The treatment was well tolerated and all four patients had a good response. One case of central nervous system (CNS) diffuse large B-cell lymphoma was treated with HDMTX alone. We conclude that, in the absence of significant organ damage, HDMTX can safely be given to liver transplant patients, but should only be administered in specialist oncology units. Proof of effectiveness as a single agent in CNS lymphoma needs further studies.
儿童移植后淋巴细胞增生性疾病（PTLD）是一种异质性疾病，其治疗方法各异，从减少免疫抑制到适度强化化疗。虽然低剂量化疗/利妥昔单抗已被证明有效，但对于复发、患有经典非霍奇金淋巴瘤或暴发性PTLD的患者，需要进行适度强化化疗。甲氨蝶呤（Mtx）在淋巴瘤治疗中非常有效，且能穿过血脑屏障。然而，文献中没有关于其在肝移植患者中安全性的数据。我们描述了4例肝移植后高级别淋巴瘤（3例弥漫性大B细胞淋巴瘤和1例T细胞淋巴母细胞淋巴瘤），对于这些病例，包括高剂量Mtx（HDMTX）在内的化疗是首选治疗方法。总共给予了20剂HDMTX（1 - 5 g/m²）。治疗耐受性良好，所有4例患者反应良好。1例中枢神经系统（CNS）弥漫性大B细胞淋巴瘤仅接受HDMTX治疗。我们得出结论，在没有明显器官损害的情况下，HDMTX可以安全地给予肝移植患者，但仅应在专业肿瘤科室给药。HDMTX作为中枢神经系统淋巴瘤单一药物的有效性证据需要进一步研究。
