Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2024 Jan;56(1):305-313. doi: 10.4143/crt.2023.647. Epub 2023 Jul 18.
Post-transplantation lymphoproliferative disorders (PTLDs) after hematopoietic stem transplantation (HCT) or solid organ transplantation (SOT) result in poorer outcomes, including death. There are limited large cohort data on the incidence and natural course of PTLD in Asians.
We investigated PTLD using Korean national health insurance claims data of 47,518 patients who underwent HCT or SOT in 2008-2020. Patient demographics, time and type of PTLD diagnosis, type of PTLD treatment, and death data were collected. We used Fine and Gray subdistribution hazard models to calculate the cumulative incidence and risk factors for PTLD.
During median follow-up of 5.32 years, PTLD occurred in 294 of 36,945 SOT patients (0.79%) and 235 of 10,573 HCT patients (2.22%). Cumulative incidence of PTLD were 0.49% at 1 year, 1.02% at 5 years, and 1.50% at 10 years post-transplantation. Age < 20 years (subdistribution hazard ratio [SHR] of 1.67 in age 10-19, SHR 1.51 in age 0-9), HCT (SHR 3.02), heart transplantation (SHR 2.27), and liver transplantation (SHR 1.47) were significant risk factors for PTLD. The presence of PTLD was associated with an increased risk of death (hazard ratio of 2.84). Overall, 5-year survival of PTLD patients was 68.9% (95% confidence interval, 64.9 to 73.2).
We observed a steady increase in PTLD over 10 years after HCT or SOT in this large cohort study. Pediatric age group, HCT, liver transplantation, and heart transplantation were suggested to be risk factors for PTLD, and PTLD was associated with a higher risk of death.
造血干细胞移植（HCT）或实体器官移植（SOT）后发生的移植后淋巴组织增生性疾病（PTLD）导致预后较差，包括死亡。亚洲人群中关于 PTLD 的发病率和自然病程的大型队列数据有限。
我们使用 2008 年至 2020 年期间接受 HCT 或 SOT 的 47518 名患者的韩国国家健康保险索赔数据，调查了 PTLD。收集了患者人口统计学、PTLD 诊断时间和类型、PTLD 治疗类型以及死亡数据。我们使用 Fine 和 Gray 亚分布风险模型计算了 PTLD 的累积发生率和危险因素。
在中位随访 5.32 年期间，36945 例 SOT 患者中有 294 例（0.79%）和 10573 例 HCT 患者中有 235 例（2.22%）发生了 PTLD。PTLD 的累积发生率为移植后 1 年为 0.49%，5 年为 1.02%，10 年为 1.50%。年龄<20 岁（年龄 10-19 岁的亚分布风险比 [SHR]为 1.67，年龄 0-9 岁的 SHR 为 1.51）、HCT（SHR 为 3.02）、心脏移植（SHR 为 2.27）和肝移植（SHR 为 1.47）是 PTLD 的显著危险因素。PTLD 的存在与死亡风险增加相关（风险比为 2.84）。总体而言，PTLD 患者的 5 年生存率为 68.9%（95%置信区间，64.9 至 73.2）。
在这项大型队列研究中，我们观察到 HCT 或 SOT 后 10 年内 PTLD 呈稳步上升趋势。儿科年龄组、HCT、肝移植和心脏移植被认为是 PTLD 的危险因素，PTLD 与死亡风险增加相关。
