Clinical analysis of patients with post-transplant lymphoproliferative disease
Objective:To analyze the clinical characteristics of post-transplant lymphoproliferative disease(PTLD)and explore the risk factors for its occurrence.Methods:Ten patients with pathologically diagnosed PTLD at the Second Affiliated Hospital of Army Medical University between January 2017 and December 2023 were selected as the study group.The effects of transplant precondition-ing protocol,anti-thymocyte globulin(ATG)usage,and Epstein-Barr virus(EBV)infection in donors/recipients on the occurrence and outcome of PTLD were analyzed.Using a 1:4 individual matching ratio,40 patients with hematopoietic stem cell transplantation(HSCT)during the same period at the same transplantation center were selected as the control group.General information and labora-tory indicators were compared between the two groups.Logistic regression analysis was conducted on the risk factors of PTLD.Results:The main manifestations of 10 PTLD patients in this study were fever and lymphadenectasis,including 4 cases in cervical lymph nodes,1 case in inguinal lymph nodes,1 case in retroauricular lymph nodes,and 1 case in celiac lymph nodes.In addition,there was 1 case each of lymphoid hyperplasia in the ileum,lung,and liver.The pathological types were mainly monomorphic changes(8 cases),followed by polymorphic changes(2 cases).Nine cases were derived from B cells,mainly high-proliferative activity B-cell lymphoma,and 1 case was suspected to be derived from T cells.Logistic regression analysis showed that the number of days of immuno-suppressant use and the level of EBV in donors were associated with the occurrence of PTLD.The median number of days of immuno-suppressant use was significantly lower in the PTLD group than in the control group[131.50(61.00,197.75)d vs.244.50(142.00,424.00)d,Z=2.547,P＜0.05].The proportion of EBV DNA-positive donors was significantly higher in the PTLD group than in the control group(75.0％vs.17.4％,x2=5.888,P＜0.05).The occurrence of PTLD was not significantly correlated with patient age,disease diagnosis,transplant preconditioning protocol,donor-recipient relationship,donor-recipient blood type,human leukocyte antigen(HLA)matching degree,graft versus host disease(GVHD)prevention plan,ATG usage,CMV/BK/JC virus levels,EBV levels before and after transplantation,and GVHD(P＞0.05).After the occurrence of PTLD,the survival time of patients in the R-CHOP(rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone)treatment group was significantly higher than that in the untreated and non-R-CHOP treatment groups[(345.13±110.84)d vs.(9.00±7.51)d/21.00 d,P＜0.05].Conclusion:The level of EBV DNA in do-nors and the duration of immunosuppressant use are associated with the occurrence of PTLD,suggesting that the level of EBV in donors should be monitored before transplantation,and positive donors should be given corresponding treatment.After the occurrence of PTLD,patients usually have immunosuppressants reduced or discontinued,which creates the misconception that prolonged use of immunosuppressant is a protective factor for the occurrence of PTLD.Timely R-CHOP treatment can significantly improve the prognosis and survival time of patients with PTLD.
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