Clinical analysis of EBV related post-transplantation lymphoproliferative diseases in patients after allogeneic hematopoietic stem cell transplantation / 中华器官移植杂志

ABSTRACT

Objective To summarize the clinical characteristics,diagnosis,treatment and prognosis of EBV related post-transplantation lymphoproliferative diseases (PTLD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The clinical data of 262 cases of allo-HSCT were retrospectively,and EBV-associated PTLD occurred in 9 cases after transplantation with a incidence of 3.44％ (9/262).Of the 9 patients,6 were males and 3 were females,with a median age of 19 years;the primary disease was severe aplastic anemia (SAA) in 6 cases,acute myeloid leukemia in 2 cases and chronic myeloid leukemia in 1 case Results The occurring median time of EBV associated PTLDs was 58 d (44-271 d).The clinical manifestations of most PTLD recipients were recurrent fever with no reaction to any antibiotics,antiadoncus and lymphadenectasis.Of the 9 recipients,6 cases obtained pathological diagnosis,and 3 cases clinical diagnosis.Superficial lymph node and central nervous system (CNS) involved in 8 and 4 recipients,respectively;lung and bone involvement occurred in 2 recipients and 1 case,respectively.The median number of peripheral blood EBV DNA in 9 recipients was 7.21 × 104 copies/ml (6.37 × 103-4.56 × 105 copies/ml) at the time of onset.EBV DNA in peripheral blood was positive in only one ease of 4 CNS recipients.Among 9 recipients after therapy,4 cases were cured and 4 cases were partially effective,and 1 recipient was ineffective After follow-up for 28 months (2-48 months),6 cases died,and 3 survived.Conclusion Incidence of EBV related PTLD in SAA patients undergoing allo-HSCT is relatively higher than leukemia recipients.Reduction or withdrawal of immunosuppressant,Rituximab and low dose of DLI is effective treatment.