Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder(★).
Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder(★).
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DOI：
10.1111/j.1600-6143.2010.03387.x
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发表时间：
2011-02
期刊：
影响因子：
--
通讯作者：
Tsai DE
中科院分区：
文献类型：
--
作者：
Reshef R;Vardhanabhuti S;Luskin MR;Heitjan DF;Hadjiliadis D;Goral S;Krok KL;Goldberg LR;Porter DL;Stadtmauer EA;Tsai DE
减少免疫抑制（RI）通常用于治疗实体器官移植受者移植后淋巴增生性疾病（PTLD）。我们研究了PTLD成年患者对RI的疗效、安全性和预测因素。67例患者单独接受RI治疗，30例患者接受手术切除后再进行辅助RI治疗。单纯RI的有效率为45%（完全缓解37%，部分缓解8%）。完全缓解者复发率为17%。辅助RI导致27%的复发率。含ri策略后的急性排斥率为32%，第二次移植是可行的，没有PTLD复发。单独接受RI治疗的患者中位生存期为44个月，继续接受完全免疫抑制治疗的患者中位生存期为9.5个月（p=0.07）。体积大的疾病，晚期和老年预测缺乏对RI的反应。生存分析显示了不良预后的预测因素——年龄、呼吸困难、B型症状、LDH水平、丙型肝炎、骨髓和肝脏受累。无上述因素或其中1个因素的患者3年总生存率分别为100%和79%。这些发现支持在低风险PTLD中单独使用RI，并提示预测反应和生存的因素。
Reduction of immunosuppression (RI) is commonly used to treat post-transplant lymphoproliferative disorder (PTLD) in solid organ transplant recipients. We investigated the efficacy, safety and predictors of response to RI in adult patients with PTLD. 67 patients were managed with RI alone and 30 patients were treated with surgical excision followed by adjuvant RI. The response rate to RI alone was 45% (complete response - 37%, partial response - 8%). The relapse rate in complete responders was 17%. Adjuvant RI resulted in a 27% relapse rate. The acute rejection rate following RI-containing strategies was 32% and a second transplant was feasible without relapse of PTLD. The median survival was 44 months in patients treated with RI alone and 9.5 months in patients who remained on full immunosuppression (p=0.07). Bulky disease, advanced stage and older age predicted lack of response to RI. Survival analysis demonstrated predictors of poor outcome - age, dyspnea, B symptoms, LDH level, hepatitis C, bone marrow and liver involvement. Patients with none or 1 of these factors had a 3-year overall survival of 100% and 79% respectively. These findings support the use of RI alone in low-risk PTLD and suggest factors that predict response and survival.
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影响因子：
3.1
作者：
Herzig, KA;Juffs, HG;Johnson, DW
通讯作者：
Johnson, DW
影响因子：
45.3
作者：
Maecker, Britta;Jack, Thomas;Klein, Christoph
通讯作者：
Klein, Christoph
影响因子：
8.8
作者：
Elstrom, RL;Andreadis, C;Tsai, DE
通讯作者：
Tsai, DE
影响因子：
--
作者：
Beynet, DP;Wee, SA;Kim, YH
通讯作者：
Kim, YH
影响因子：
0.9
作者：
Gill, D;Juffs, HG;Johnson, DW
通讯作者：
Johnson, DW