Institute of Pathology, Hannover Medical School, Hannover, Germany.
Transplantation. 2013 Feb 15;95(3):479-88. doi: 10.1097/TP.0b013e3182762e07.
Posttransplantation lymphoproliferative diseases (PTLD) are mainly Epstein-Barr virus (EBV)-associated disorders of B-cell origin. Due to the rarity of monomorphic T-cell PTLD (T-PTLD), knowledge about pathogenesis, risk factors, therapy, and prognosis relies predominantly on case reports and small series. Therefore, we aimed to provide an overview and a retrospective analysis of this rare PTLD subtype.
We analyzed all available articles on T-PTLD in the PubMed database as well as in our own databases (Institute of Pathology/Department of Paediatric Haematology and Oncology, Hannover Medical School) from 1988 to 2010. Reevaluated parameters were gender, age, transplanted organ, immunosuppressant regimen, time between transplantation and T-PTLD manifestation, T-PTLD subtype, virus positivity, localization, therapy, and follow-up.
A total of 163 cases were evaluated. We found that hematopoietic stem cell transplantation was associated with early-onset T-PTLD, whereas late onset occurred after immunosuppression with steroids and azathioprine without administration of calcineurin inhibitors. The major independent favorable prognostic factors were T-PTLD of the large granular lymphocytic leukemia subtype, young age, and a combination of radiotherapy/radiochemotherapy and reduced immunosuppression, whereas the hepatosplenic T-cell lymphoma subtype and cases with involvement of bone marrow, the central nervous system, or graft had an adverse prognosis.
T-PTLD is a heterogeneous group of different aberrant T-cell proliferations and represents a significant complication following transplantation, showing a uniformly poor prognosis.
移植后淋巴组织增生性疾病（PTLD）主要是 Epstein-Barr 病毒（EBV）相关的 B 细胞起源的疾病。由于单形性 T 细胞 PTLD（T-PTLD）较为罕见，因此关于其发病机制、危险因素、治疗和预后的知识主要依赖于病例报告和小系列研究。因此，我们旨在提供这种罕见的 PTLD 亚型的概述和回顾性分析。
我们分析了 1988 年至 2010 年期间在 PubMed 数据库和我们自己的数据库（汉诺威医学院病理学研究所/儿科血液学和肿瘤学系）中所有关于 T-PTLD 的可用文章。重新评估的参数包括性别、年龄、移植器官、免疫抑制剂方案、移植后与 T-PTLD 表现之间的时间、T-PTLD 亚型、病毒阳性、定位、治疗和随访。
共评估了 163 例病例。我们发现造血干细胞移植与 T-PTLD 的早期发病有关，而在不使用钙调神经磷酸酶抑制剂的情况下使用类固醇和硫唑嘌呤进行免疫抑制后则会发生晚期发病。主要的独立预后良好因素是大颗粒淋巴细胞白血病亚型的 T-PTLD、年轻年龄以及放疗/放化疗联合减少免疫抑制，而肝脾 T 细胞淋巴瘤亚型以及骨髓、中枢神经系统或移植物受累的病例则预后不良。
T-PTLD 是一组不同的异常 T 细胞增殖，是移植后的一种严重并发症，预后普遍较差。
