瑞士实体器官移植后移植后淋巴细胞增生性疾病的5年累积发病率较低。

Low 5-year cumulative incidence of post-transplant lymphoproliferative disorders after solid organ transplantation in Switzerland.

作者信息

Steiner Raphael, Kridel Robert, Giostra Emiliano, McKee Thomas, Achermann Rita, Mueller Nicolas, Manuel Oriol, Dickenmann Michael, Schuurmans Macé M, de Leval Laurence, Fehr Thomas, Tinguely Marianne, Binet Isabelle, Cogliatti Sergio, Haralamvieva Eugenia, Koller Michael, Dietrich Pierre-Yves

机构信息

Centre of Oncology, University Hospitals of Geneva, Switzerland.

Princess Margaret Cancer Centre - UHN, Toronto, Ontario, Canada.

出版信息

Swiss Med Wkly. 2018 Mar 8;148:w14596. doi: 10.4414/smw.2018.14596. eCollection 2018.

DOI:10.4414/smw.2018.14596

PMID:29518251

Abstract

BACKGROUND

Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of transplantation occurring in the setting of immunosuppression and oncogenic viral infections. However, little is known about the cumulative incidence, histological subtypes, risk determinants and outcome of PTLD in solid organ transplant (SOT) recipients in Switzerland.

METHODS

This retrospective observational study investigated adult SOT recipients from two sequential cohorts, the pre-SCTS (Swiss Transplant Cohort Study) series, with data collected from January 1986 to April 2008, and the STCS series, with data collected from May 2008 to December 2014 in Switzerland. SOT recipients were cross-referenced with the data of all the patients with a lymphoma diagnosis in each transplant centre and with the data of the Swiss Transplant Cohort Study (STCS) to determine the cumulative incidence of PTLD, pre-therapeutic clinical features, clinical course and outcome. Kaplan-Meier analysis was performed for overall survival after PTLD.

RESULTS

We identified 79 cases of PTLD during the study period in the two cohorts: pre-STCS from 1986 to 2008 (n = 62) and STCS from 2008 to 2014 (n = 17). Histological subgroups included: early lesions (pre-STCS n = 2, STCS n = 0); polymorphic PTLD (pre-STCS n = 8, STCS n = 7); monomorphic PTLD (pre-STCS n = 47, STCS n = 10), and Hodgkin's lymphoma (pre-STCS n = 5, STCS n = 0). Median time to PTLD diagnosis was 90 months (range 3-281 months) and 14 months (range 2-59 months) in the pre-STCS and STCS cohorts, respectively. Median follow-up after transplantation was 141 months for the pre-STCS patients and 33 months for the STCS patients. Cumulative incidences of PTLD during the STCS period at 0.5, 1 and 5 years were 0.17% (95% confidence interval 0.07-0.46%), 0.22% (0.09-0.53%) and 0.96% (0.52-1.80%), respectively. For the pre-STCS case series, it was not possible to estimate the incidence rate of PTLD. Survival after PTLD diagnosis was 80% (68-87%) at 1 year and 56% (42-68%) at 5 years for the pre-STCS and STCS cohorts combined.

CONCLUSIONS

At 5 years, the cumulative incidence of PTLD, regardless of the organ transplanted, was only 0.96% in the STCS cohort, which is lower than that reported in the literature.

摘要

背景

移植后淋巴组织增生性疾病（PTLD）是移植后发生的一种潜在威胁生命的并发症，发生于免疫抑制和致癌性病毒感染的背景下。然而，对于瑞士实体器官移植（SOT）受者中PTLD的累积发病率、组织学亚型、风险决定因素及预后知之甚少。

方法

这项回顾性观察性研究调查了来自两个连续队列的成年SOT受者，即SCTS前（瑞士移植队列研究）系列，数据收集于1986年1月至2008年4月，以及STCS系列，数据收集于2008年5月至2014年12月的瑞士。SOT受者与每个移植中心所有淋巴瘤诊断患者的数据以及瑞士移植队列研究（STCS）的数据进行交叉对照，以确定PTLD的累积发病率、治疗前临床特征、临床病程及预后。对PTLD后的总生存期进行Kaplan-Meier分析。

结果

在研究期间，我们在两个队列中确定了79例PTLD：1986年至2008年的SCTS前队列（n = 62）和2008年至2014年的STCS队列（n = 17）。组织学亚组包括：早期病变（SCTS前队列n = 2，STCS队列n = 0）；多形性PTLD（SCTS前队列n = 8，STCS队列n = 7）；单形性PTLD（SCTS前队列n = 47，STCS队列n = 10），以及霍奇金淋巴瘤（SCTS前队列n = 5，STCS队列n = 0）。SCTS前队列和STCS队列中PTLD诊断的中位时间分别为90个月（范围3 - 281个月）和14个月（范围2 - 59个月）。SCTS前患者移植后的中位随访时间为141个月，STCS患者为33个月。STCS期间PTLD在0.5年、1年和5年的累积发病率分别为0.17%（95%置信区间0.07 - 0.46%）、0.22%（0.09 - 0.53%）和0.96%（0.52 - 1.80%）。对于SCTS前病例系列，无法估计PTLD的发病率。SCTS前队列和STCS队列合并后，PTLD诊断后1年的生存率为80%（68 - 87%），5年为56%（42 - 68%）。