Dang Brian N, Ch'ng James, Russell Matthew, Cheng Jerry C, Moore Theodore B, Alejos Juan C
Division of Pediatric Hematology and Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
Division of Pediatric Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
Pediatr Transplant. 2021 Aug;25(5):e13861. doi: 10.1111/petr.13861. Epub 2020 Oct 1.
Post-transplant lymphoproliferative disorders (PTLD) are a group of lesions that can complicate solid organ or hematopoietic stem cell transplantation and are often associated with Epstein-Barr virus (EBV). The treatment of PTLD is dependent on the type of lesion and includes a wide range of therapies, but chimeric antigen receptor (CAR) T-cell therapy has not previously been reported as a treatment option for PTLD. We present a patient who developed refractory PTLD in her right retroperitoneum, right inguinal and iliac chains, and right axillary region shortly after heart transplantation and was treated with CAR T-cell therapy. She could not tolerate complete discontinuation of immunosuppression due to the risk of rejection of a life-supporting graft. The patient's PTLD responded to CAR T-cell therapy, and her heart was monitored throughout the treatment course without any signs of rejection or ventricular dysfunction. CAR T-cell therapy may be a viable treatment option in patients who develop PTLD after a solid organ transplant.
移植后淋巴细胞增生性疾病（PTLD）是一组可使实体器官或造血干细胞移植复杂化的病变，且常与 Epstein-Barr 病毒（EBV）相关。PTLD 的治疗取决于病变类型，包括多种治疗方法，但嵌合抗原受体（CAR）T 细胞疗法此前尚未被报道作为 PTLD 的一种治疗选择。我们报告了一名患者，她在心脏移植后不久，右侧腹膜后、右侧腹股沟和髂淋巴结以及右侧腋窝区域出现了难治性 PTLD，并接受了 CAR T 细胞疗法治疗。由于存在维持生命的移植物排斥风险，她无法耐受完全停用免疫抑制剂。该患者的 PTLD 对 CAR T 细胞疗法有反应，并且在整个治疗过程中对其心脏进行了监测，未发现任何排斥或心室功能障碍的迹象。CAR T 细胞疗法可能是实体器官移植后发生 PTLD 患者的一种可行治疗选择。
