Ashrafi Farzaneh, Shahidi Shahrzad, Mehrzad Valiollah, Mortazavi Mojgan, Hosseini Sayyideh Forough
Hematology Oncology Division, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Nephrology Division, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Hematol Oncol Stem Cell Res. 2021 Oct 1;15(4):239-248. doi: 10.18502/ijhoscr.v15i4.7479.
One of the important causes of mortality and morbidity in kidney transplanted patients is Post Transplant Lymphoproliferative Disease (PTLD), which is due to immunosuppression therapy and viral activity. It seems that Rapamycin, with dual antineoplastic and immunosuppressive effects, may have a pivotal role in the treatment of PTLD patients and preserving transplanted kidneys. Twenty patients with PTLD were enrolled. Immunosuppressive therapy was reduced or ceased, and Rapamycin was initiated at the time of PTLD diagnosis. We evaluated the effects of switching immunosuppressive drugs to Rapamycin on graft status, the response of tumor, and 6, 12 months, and 5-year survival in patients. PTLD remission was achieved in 14 patients, while six patients died; no relapse was detected in recovered patients. The median of PTLD free time was 25 months, and the mean overall survival in patients with PTLD treated by Rapamycin was 84.8 (95% CI=61.3-108.23).The five-year survival rate was 67%, 12 months survival was 73.8%, and six months' survival was 80%. The response rate to Rapamycin and immunosuppression reduction alone was 46.6%. Four out of 13 Diffuse Large B-Cell Lymphoma patients achieved a complete response just only after the reduction of immunosuppressive drugs and the consumption of Rapamycin. The present study demonstrated the effectiveness of conversion from immunosuppressive medication, particularly of Calcineurin inhibitors to Rapamycin in PTLD patients. However, more research is needed to confirm the Rapamycin effect on patients with PTLD.
肾移植患者死亡和发病的重要原因之一是移植后淋巴细胞增生性疾病（PTLD），这是由免疫抑制治疗和病毒活动引起的。雷帕霉素具有抗肿瘤和免疫抑制双重作用，似乎在PTLD患者的治疗及保护移植肾方面可能发挥关键作用。招募了20例PTLD患者。在PTLD诊断时，减少或停止免疫抑制治疗，并开始使用雷帕霉素。我们评估了将免疫抑制药物转换为雷帕霉素对移植物状态、肿瘤反应以及患者6个月、12个月和5年生存率的影响。14例患者实现了PTLD缓解，而6例患者死亡；康复患者未检测到复发。PTLD无病时间的中位数为25个月，接受雷帕霉素治疗的PTLD患者的平均总生存期为84.8（95%CI=61.3-108.23）。五年生存率为67%，12个月生存率为73.8%，6个月生存率为80%。单独使用雷帕霉素和减少免疫抑制的缓解率为46.6%。13例弥漫性大B细胞淋巴瘤患者中有4例仅在减少免疫抑制药物并使用雷帕霉素后实现了完全缓解。本研究证明了在PTLD患者中从免疫抑制药物，特别是钙调神经磷酸酶抑制剂转换为雷帕霉素的有效性。然而，需要更多研究来证实雷帕霉素对PTLD患者的作用。
