Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Curr Oncol Rep. 2010 Nov;12(6):383-94. doi: 10.1007/s11912-010-0132-1.
Post-transplantation lymphoproliferative disorders (PTLD) are a heterogenous group of abnormal lymphoid proliferations that occur after solid organ transplant (SOT) or hematopoietic transplantation. PTLDs consist of a disease spectrum ranging from hyperplasia to aggressive lymphomas with 60-70% being Epstein-Barr virus positive. The majority of cases are B-cell, although 10-15% are of T-cell origin or rarely Hodgkin lymphoma. Recent SOT series suggest PTLD occurs at a median of 36-40 months after transplant. Clinically, extra-nodal disease is common (up to 75-85%) including CNS involvement, which is seen in 10-15% of all cases. Since the first report over 40 years ago, PTLD has remained one of the most morbid complications associated with SOT. However, recent data suggests improved survival in the modern era, especially with the integration of early rituximab-based therapy. These studies utilized first line rituximab (+/- chemotherapy) together with reduced immune suppression (RI) for monomorphic and polymorphic PTLD. It will be critical in future studies to determine which PTLDs are most amenable to initial therapy with RI alone, versus RI/rituximab, versus RI/rituximab/chemotherapy. Additionally, novel therapeutics, such as adoptive immunotherapy, should continue to be explored.
移植后淋巴组织增生性疾病（PTLD）是一组异质性的异常淋巴增生性疾病，发生于实体器官移植（SOT）或造血干细胞移植后。PTLD 由一系列疾病谱组成，从增生到侵袭性淋巴瘤，其中 60-70%为 EBV 阳性。大多数病例为 B 细胞起源，尽管 10-15%为 T 细胞起源或罕见霍奇金淋巴瘤。最近的 SOT 系列研究表明，PTLD 发生在移植后中位 36-40 个月。临床上，结外疾病常见（高达 75-85%），包括中枢神经系统受累，在所有病例中占 10-15%。自 40 多年前首例报告以来，PTLD 一直是与 SOT 相关的最严重的并发症之一。然而，最近的数据表明，在现代，PTLD 的生存率有所提高，尤其是在早期应用利妥昔单抗为基础的治疗后。这些研究使用一线利妥昔单抗（+/-化疗）联合减少免疫抑制（RI）治疗单形性和多形性 PTLD。在未来的研究中，确定哪些 PTLD 最适合单独用 RI 初始治疗，哪些适合 RI/利妥昔单抗，哪些适合 RI/利妥昔单抗/化疗，将是至关重要的。此外，应继续探索新的治疗方法，如过继免疫疗法。
