Trappe R, Hinrichs C, Appel U, Babel N, Reinke P, Neumayer H-H, Budde K, Dreyling M, Dührsen U, Kliem V, Schüttrumpf S, Hauser I A, Mergenthaler H-G, Schlattmann P, Anagnostopoulos I, Doerken B, Riess H
Department of Hematology, Campus Virchow-Klinikum, Charite-Universitatsmedizin Berlin, Berlin, Germany.
Am J Transplant. 2009 Oct;9(10):2331-7. doi: 10.1111/j.1600-6143.2009.02772.x. Epub 2009 Aug 6.
We addressed the effect of post-transplant lymphoproliferative disorder (PTLD) treatment with rituximab monotherapy or CHOP-based chemotherapy (+/- rituximab) after upfront immunosuppression reduction (IR) on renal graft function in a longitudinal analysis of 58 renal transplant recipients with PTLD and 610 renal transplant controls. Changes in the estimated glomerular filtration rate over time were calculated from a total of 6933 creatinine measurements over a period of >1 year using a linear mixed model with random and fixed effects. Renal graft function significantly improved with treatment of PTLD, especially in the chemotherapy subgroup. Patients treated with IR+chemotherapy +/- rituximab had a noninferior graft function compared with untreated controls suggesting that the negative impact of IR on the renal graft function can be fully compensated by the immunosuppressive effect of CHOP. The immunosuppressive effect of single agent rituximab may partially compensate the negative impact of IR on the graft function. Thus, it is possible to reduce immunosuppression when using chemotherapy to treat PTLD.
我们在一项针对58例肾移植后发生移植后淋巴细胞增生性疾病（PTLD）的患者及610例肾移植对照者的纵向分析中，探讨了在预先降低免疫抑制（IR）后，使用利妥昔单抗单药治疗或基于CHOP的化疗（±利妥昔单抗）治疗PTLD对肾移植功能的影响。使用具有随机效应和固定效应的线性混合模型，根据超过1年时间内总共6933次肌酐测量值计算出估计肾小球滤过率随时间的变化。PTLD治疗后肾移植功能显著改善，尤其是在化疗亚组中。接受IR +化疗±利妥昔单抗治疗的患者与未治疗的对照者相比，移植肾功能不差，这表明IR对肾移植功能的负面影响可通过CHOP的免疫抑制作用得到完全补偿。单药利妥昔单抗的免疫抑制作用可能部分补偿IR对移植功能的负面影响。因此，在使用化疗治疗PTLD时有可能降低免疫抑制。
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