Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden.
Acta Oncol. 2021 Jun;60(6):771-778. doi: 10.1080/0284186X.2021.1904520. Epub 2021 Apr 1.
Treatment with antithymocyte globulin (ATG) is a well-recognized risk factor for the development of post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation, but it is unknown how its use affects overall survival after PTLD. A total of 114 patients with PTLD and available data on immunosuppressive regimen were included from a nation-wide case series of solid organ transplant recipients in Sweden. Prior use of ATG was correlated to clinical features, PTLD subtype, and survival. A total of 47 (41%) patients had received ATG prior to the diagnosis of PTLD. The ATG-treated patients were more likely to be recipients of hearts or lungs, and less likely of kidneys ( < 0.01). They had experienced more acute rejections ( = 0.02). The PTLDs arose earlier, median 2.0 vs. 6.6 years post-transplant ( = 0.002) and were more often situated in the allograft (32% vs. 7%, < 0.001) in patients with prior ATG vs. no ATG treatment. The PTLDs in the ATG group were more often Epstein-Barr virus-positive (80% vs. 40%, < 0.001). There were more polymorphic PTLDs (17% vs. 1.5%, = 0.004) and less T-cell PTLDs (4% vs. 19%, = 0.02) in the ATG group than in the no ATG group. Diffuse large B-cell lymphoma was equally common in patients with and without prior ATG therapy, but the non-germinal center subtype was more frequent in the ATG group ( = 0.001). In an adjusted Cox proportional hazards regression model, prior ATG treatment and better performance status were associated with superior overall survival, whereas older age, T-cell subtype of PTLD, presence of B symptoms, and elevated lactate dehydrogenase were associated with inferior overall survival. Patients receiving ATG solely as rejection therapy had superior overall survival compared with those receiving ATG as induction therapy or both ( = 0.03). ATG therapy, especially rejection therapy, prior to PTLD development is an independent prognostic factor for superior overall survival after PTLD diagnosis.
抗胸腺细胞球蛋白（ATG）治疗是实体器官移植后发生移植后淋巴组织增生性疾病（PTLD）的公认危险因素，但尚不清楚其使用如何影响 PTLD 后的总生存。从瑞典一项全国性实体器官移植受者病例系列中纳入了 114 例有 PTLD 且有免疫抑制方案数据的患者。分析了 ATG 应用与临床特征、PTLD 亚型和生存的相关性。在诊断为 PTLD 之前，共有 47 例（41%）患者接受过 ATG 治疗。接受 ATG 治疗的患者更可能是心脏或肺移植受者，而不是肾脏移植受者（ < 0.01）。他们经历了更多的急性排斥反应（ = 0.02）。PTLD 更早发生，中位时间分别为移植后 2.0 年和 6.6 年（ = 0.002），且在前 ATG 治疗组中更常见于移植物中（32% vs. 7%， < 0.001）。在前 ATG 治疗组中，PTLD 更常为 EBV 阳性（80% vs. 40%， < 0.001），多形性 PTLD 更常见（17% vs. 1.5%， = 0.004），T 细胞 PTLD 较少（4% vs. 19%， = 0.02）。在前 ATG 治疗组和无 ATG 治疗组中弥漫性大 B 细胞淋巴瘤的发生率相同，但非生发中心亚型在前 ATG 治疗组中更常见（ = 0.001）。在调整后的 Cox 比例风险回归模型中，先前的 ATG 治疗和更好的表现状态与总生存的改善相关，而年龄较大、PTLD 的 T 细胞亚型、B 症状的存在和乳酸脱氢酶的升高与总生存的降低相关。仅因排斥反应而接受 ATG 治疗的患者的总生存优于因诱导治疗或两者均接受 ATG 治疗的患者（ = 0.03）。PTLD 发生前接受 ATG 治疗，尤其是排斥反应治疗，是 PTLD 诊断后总生存的独立预后因素。
