Caillard Sophie, Imhoff Olivier, Moulin Bruno
Service de néphrologie-transplantation, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
Nephrol Ther. 2011 Nov;7(6):500-12. doi: 10.1016/j.nephro.2011.03.005. Epub 2011 Apr 30.
Post-transplant hemopathies are a serious complication of organ transplantation. They include several entities: non-hodgkin lymphoma, Hodgkin disease and myeloma. The pathophysiology, clinical and histological features, treatment and evolution of these diseases are different, but share some similarities. Among factors involved in lymphomagenesis, the role of Epstein Barr virus and immunosuppression are central. EBV primo-infection or reactivation together with a deep depression of T-cell immunity is at particular risk of lymphoma development. The clinical expression and outcome of lymphomas are varied. Assays for EBV replication quantification have been developed leading to immunosuppression decreasing and antiviral therapy when the replication increases. Treatment of post-transplant lymphoproliferations consists mainly in immunotherapy and chemotherapy. Hodgkin disease and myeloma are rare after transplantation; their management is close to the one of immunocompetent patients. The recurrence of myeloma, amyloidosis or light chain deposition disease seems frequent after transplantation and only patients with disappearance of monoclonal component should be proposed for transplantation. On the opposite, the risk of recurrence appears lower for Hodgkin disease; therefore the transplantation of patients with a history of Hodgkin disease looks possible.
移植后血液系统疾病是器官移植的一种严重并发症。它们包括几种类型：非霍奇金淋巴瘤、霍奇金病和骨髓瘤。这些疾病的病理生理学、临床和组织学特征、治疗及转归各不相同，但也有一些相似之处。在淋巴瘤发生的相关因素中，爱泼斯坦-巴尔病毒（Epstein Barr virus，EBV）和免疫抑制的作用至关重要。EBV初次感染或再激活，以及T细胞免疫的深度抑制，都特别容易引发淋巴瘤。淋巴瘤的临床表型和转归各不相同。已开发出EBV复制定量检测方法，当复制增加时可据此减少免疫抑制并进行抗病毒治疗。移植后淋巴组织增生性疾病的治疗主要包括免疫治疗和化疗。移植后霍奇金病和骨髓瘤较为罕见，其治疗方法与免疫功能正常的患者相近。移植后骨髓瘤、淀粉样变性或轻链沉积病的复发似乎很常见，仅应将单克隆成分消失的患者纳入移植范围。相反，霍奇金病的复发风险似乎较低；因此，有霍奇金病病史的患者进行移植似乎是可行的。
