Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature
Plasma cell neoplasia after kidney transplantation: French cohort series and review of the literature
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DOI：
10.1371/journal.pone.0179406
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发表时间：
2017-06-21
期刊：
影响因子：
3.7
通讯作者：
Peltier, Julie
中科院分区：
文献类型：
--
作者：
Kormann, Raphael;Francois, Helene;Peltier, Julie
虽然移植后淋巴细胞增生性疾病（PTLD）是肾移植（KT）中第二常见的癌症类型，但浆细胞瘤（PCN）在KT后很少发生，对其特征和演变知之甚少。我们纳入了22例1991年至2013年间发生的移植后PCN病例。其中包括12例症状性多发性骨髓瘤，8例惰性骨髓瘤和2例浆细胞瘤。诊断时的中位年龄为56.5岁，移植后的中位发病时间为66.7个月（2-252）。8例惰性骨髓瘤中有4例在33个月（6-72）后发展为症状性骨髓瘤。9例患者出现pcn相关性肾移植功能障碍，其中铸型肾病6例，轻链沉积病2例，淀粉样变性1例。PCN诊断时血清肌酐由135.7（+/- 71.6）升高至195.9 (+/- 123.7)+/- mol/l （p = 0.008）。移植后，诊断为PCN后的年细菌感染率明显升高，从0.16（+/- 0.37）增加到1.09 (+/- 1.30)（p = 0.0005）。PCN前后的病毒感染情况无差异。确诊PCN后急性排斥反应风险降低（确诊前为36%，确诊后为0%，p = 0.004），提示同种异体反应降低。13例（59%）患者死亡，其中12例与血液病直接相关。移植和患者的中位生存期分别为31.7个月和49.4个月。与一般人群相比，KT后PCN发生在年轻患者中，具有相同的临床特征，但与频繁的细菌感染和血液学疾病复发相关，严重影响移植物和患者的生存。
Although post-transplant lymphoproliferative disorder (PTLD) is the second most common type of cancer in kidney transplantation (KT), plasma cell neoplasia (PCN) occurs only rarely after KT, and little is known about its characteristics and evolution. We included twenty-two cases of post-transplant PCN occurring between 1991 and 2013. These included 12 symptomatic multiple myeloma, eight indolent myeloma and two plasmacytomas. The median age at diagnosis was 56.5 years and the median onset after transplantation was 66.7 months (2-252). Four of the eight indolent myelomas evolved into symptomatic myeloma after a median time of 33 months (6-72). PCN-related kidney graft dysfunction was observed in nine patients, including six cast nephropathies, two light chain deposition disease and one amyloidosis. Serum creatinine was higher at the time of PCN diagnosis than before, increasing from 135.7 (+/- 71.6) to 195.9 (+/- 123.7) +/- mol/l (p = 0.008). Following transplantation, the annual rate of bacterial infections was significantly higher after the diagnosis of PCN, increasing from 0.16 (+/- 0.37) to 1.09 (+/- 1.30) (p = 0.0005). No difference was found regarding viral infections before and after PCN. Acute rejection risk was decreased after the diagnosis of PCN (36% before versus 0% after, p = 0.004), suggesting a decreased allogeneic response. Thirteen patients (59%) died, including twelve directly related to the hematologic disease. Median graft and patient survival was 31.7 and 49.4 months, respectively. PCN after KT occurs in younger patients compared to the general population, shares the same clinical characteristics, but is associated with frequent bacterial infections and relapses of the hematologic disease that severely impact the survival of grafts and patients.