Kormann Raphaël, François Hélène, Moles Thibault, Dantal Jacques, Kamar Nassim, Moreau Karine, Bachelet Thomas, Heng Anne-Elisabeth, Garstka Antoine, Colosio Charlotte, Ducloux Didier, Sayegh Johnny, Savenkoff Benjamin, Viglietti Denis, Sberro Rebecca, Rondeau Eric, Peltier Julie
Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Pierre et Marie Curie, Paris, France.
Service de Néphrologie, Hôpital Bicêtre, APHP, Université Paris Sud, Paris, France.
PLoS One. 2017 Jun 21;12(6):e0179406. doi: 10.1371/journal.pone.0179406. eCollection 2017.
Although post-transplant lymphoproliferative disorder (PTLD) is the second most common type of cancer in kidney transplantation (KT), plasma cell neoplasia (PCN) occurs only rarely after KT, and little is known about its characteristics and evolution. We included twenty-two cases of post-transplant PCN occurring between 1991 and 2013. These included 12 symptomatic multiple myeloma, eight indolent myeloma and two plasmacytomas. The median age at diagnosis was 56.5 years and the median onset after transplantation was 66.7 months (2-252). Four of the eight indolent myelomas evolved into symptomatic myeloma after a median time of 33 months (6-72). PCN-related kidney graft dysfunction was observed in nine patients, including six cast nephropathies, two light chain deposition disease and one amyloidosis. Serum creatinine was higher at the time of PCN diagnosis than before, increasing from 135.7 (±71.6) to 195.9 (±123.7) μmol/l (p = 0.008). Following transplantation, the annual rate of bacterial infections was significantly higher after the diagnosis of PCN, increasing from 0.16 (±0.37) to 1.09 (±1.30) (p = 0.0005). No difference was found regarding viral infections before and after PCN. Acute rejection risk was decreased after the diagnosis of PCN (36% before versus 0% after, p = 0.004), suggesting a decreased allogeneic response. Thirteen patients (59%) died, including twelve directly related to the hematologic disease. Median graft and patient survival was 31.7 and 49.4 months, respectively. PCN after KT occurs in younger patients compared to the general population, shares the same clinical characteristics, but is associated with frequent bacterial infections and relapses of the hematologic disease that severely impact the survival of grafts and patients.
尽管移植后淋巴增殖性疾病（PTLD）是肾移植（KT）中第二常见的癌症类型，但浆细胞肿瘤（PCN）在KT后很少发生，对其特征和演变了解甚少。我们纳入了1991年至2013年间发生的22例移植后PCN病例。其中包括12例有症状的多发性骨髓瘤、8例惰性骨髓瘤和2例浆细胞瘤。诊断时的中位年龄为56.5岁，移植后的中位发病时间为66.7个月（2 - 252个月）。8例惰性骨髓瘤中有4例在中位时间33个月（6 - 72个月）后演变为有症状的骨髓瘤。9例患者出现了与PCN相关的肾移植功能障碍，包括6例管型肾病、2例轻链沉积病和1例淀粉样变性。PCN诊断时的血清肌酐高于诊断前，从135.7（±71.6）μmol/l增至195.9（±123.7）μmol/l（p = 0.008）。移植后，PCN诊断后的细菌感染年发生率显著升高，从0.16（±0.37）增至1.09（±1.30）（p = 0.0005）。PCN前后的病毒感染情况未发现差异。PCN诊断后急性排斥反应风险降低（诊断前为36%，诊断后为0%，p = 0.004），提示同种异体反应降低。13例患者（59%）死亡，其中12例直接与血液系统疾病相关。移植肾和患者的中位生存期分别为31.7个月和49.4个月。与一般人群相比，KT后PCN发生于较年轻的患者，具有相同的临床特征，但与频繁的细菌感染和血液系统疾病复发相关，严重影响移植肾和患者的生存。
