Post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation: a case report, meta-analysis, and systematic review.

Autor: Su YY; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Yu YF; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Yan ZY; North China University of Science and Technology Affiliated Hospital, Tangshan, China., Zhao YJ; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China. zhaoyajing93115@163.com., Lou JW; Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China., Xue F; Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China., Xu M; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Feng Q; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Ji XB; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Dong XY; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Wang W; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Liu CF; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Peng J; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China., Liu XG; Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, China. liuxingrant@163.com.; Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. liuxingrant@163.com.
Jazyk: angličtina
Zdroj: Diagnostic pathology [Diagn Pathol] 2024 Sep 07; Vol. 19 (1), pp. 122. Date of Electronic Publication: 2024 Sep 07.
DOI: 10.1186/s13000-024-01544-8
Abstrakt: Background: Post-transplant lymphoproliferative disorders (PTLD) are rare but severe complications that occur after solid organ or allogeneic hematopoietic stem cell transplantations (allo-HSCT), with rapid progression and high mortality. Primary central nervous system (CNS)-PTLD are rarely recognized histo-pathologically. In addition, the diagnostic value of the Epstein-Barr virus (EBV) DNA copies in CNS-PTLD remains poorly understood.
Objectives: We herein report a case of monomorphic EBV-associated CNS-PTLD (diffuse large B-cell lymphoma, DLBCL) after allo-HSCT and perform a meta-analysis to assess the efficacy of PTLD treatment strategies in recent years.
Methods: We present the case report covering clinical manifestations, diagnosis, treatment, and outcomes of a patient with primary CNS-PTLD. Additionally, we include a systematic review and meta-analysis of the clinical characteristics of 431 patients with PTLD after allo-HSCT. We evaluate the main treatment options and outcomes of PTLD management, including rituximab, chemotherapies, and autologous or human leukocyte antigen (HLA)-matched EBV-specific cytotoxic T lymphocyte infusion (EBV-CTLs)/donor lymphocyte infusion (DLI).
Results: The meta-analysis revealed an overall response rate of 69.0% for rituximab alone (95% CI: 0.47-0.84), 45.0% for rituximab plus chemotherapies (95% CI: 0.15-0.80), and 91.0% for rituximab plus EBV-CTLs/DLI (95% CI: 0.83-0.96). The complete response (CR) rate after treatments for PTLD was 67.0% (95% CI: 0.56-0.77). Moreover, the 6-month and 1-year overall survival (OS) rate was 64.0% (95% CI: 0.31-0.87) and 49.0% (95% CI: 0.31-0.68), respectively.
Conclusions: This case highlighted the urgent need for effective, low-toxic treatment regimens for CNS-PTLD. Our meta-analysis suggested that rituximab combined with EBV-CTLs/DLI could be a favorable strategy for the management of PTLD after allo-HSCT.
(© 2024. The Author(s).)
Databáze: MEDLINE
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