First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study
First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study
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DOI：
10.1111/ejh.12782
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发表时间：
2017-01-01
影响因子：
3.1
通讯作者：
Panizo, Carlos
中科院分区：
文献类型：
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作者：
Martinez-Calle, Nicolas;Alfonso, Ana;Panizo, Carlos
本回顾性研究在单中心队列中评估利妥昔单抗对PTLD反应和生存的影响。包括1984年至2009年间的PTLD病例，包括心脏、肾脏、肝脏和肺移植接受者。生存率分析考虑了PTLD的类型（单型vs多型）、EBV感染状态、IPI评分、Ann Arbor分期和美罗华单抗的使用。1335例移植患者中，24例发生PTLD。中位年龄为54岁（范围29-69），中位诊断时间为50个月（范围0-100）。PTLD型以晚期/单形态型为主（79%和75%），以弥漫性大b细胞型为主。总缓解率（ORR）为62%（66%利妥昔单抗vs 50%非利妥昔单抗；P = 0.5）。r - chop样方案的使用频率最高（72%的患者接受利妥昔单抗治疗）。中位总生存期为64个月（CI 95% 31-96）。接受利妥昔单抗治疗的患者OS显著增加（P = 0.01; CI 95%；利妥昔单抗治疗58-79个月；非利妥昔单抗治疗1-30个月）。除环孢素A （CyA）与移植后到达PTLD的时间增加相关外，移植后免疫抑制方案对存活和到达PTLD的时间没有影响（P = 0.02）。在我们的单中心系列研究中，利妥昔单抗与生存率增加相关，应考虑将其作为PTLD患者的一线治疗。应前瞻性评价CyA对PTLD发展可能的保护作用。
This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.