摘要
目的探讨肾移植术后合并非霍奇金淋巴瘤（NHL）的临床特点、治疗和预后。方法回顾性分析1998年1月至2012年10月2045例患者行同种异体肾移植术后发生NHL的12例患者临床特点、疗效及预后。结果12例NHL患者中男5例，女7例，确诊NHL时中位年龄52．5（30～68）岁，确诊NHL距肾移植术的中位时间84（12～253）个月。肾移植后2、5和10年合并NHL发生率分别为0．10％、0．15％和0．44％。发病部位多样，绝大部分在淋巴结之外，包括颅内、胃、肝脏、肾脏、胰腺、子宫、肋骨、皮肤及软组织、咽淋巴环。所有患者病理类型均为弥漫大B细胞淋巴瘤。所有患者首先将免疫抑制剂减量，然后采用其他治疗方法，其中单纯手术治疗3例，单纯化疗6例，手术联合化疗l例，化疗联合放疗1例，放弃治疗1例。完全缓解8例，部分缓解1例，病情进展2例，总有效率81．8％。中位随访时间11．5（1～130）个月。死亡3例。结论肾移植术后合并NHL发病模式呈双峰分布。临床表现各异且无特异性症状。病理类型以弥漫大B细胞淋巴瘤多见。仅依赖免疫抑制剂减量治疗无效，CHOP方案加或不加利妥昔单抗治疗有效。
Objective To investigate the clinical characteristics and therapeutic outcomes of non- Hodgkin lymphoma （NHL） occurring after renal transplantation. Methods We reviewed a total population of 2045 adult kidney recipients between January 1998 and October 2012, 12 of which developed NHL. Their clinical features and outcomes were analyzed. Results 12 patients with a median age of 52.5 （range： 30-68） years old , including 5 males and 7 females, were diagnosed as diffuse large B-cell lymphoma （DLBCL） at a median interval of 84 （range： 12-253） months after transplantation. The incidences of developing NHL at 2-year, 5-year and 10-year were 0.10%, 0.15% and 0.44%, respectively. The locations of lymphoma were diverse, including central nervous system, stomach, liver, kidney, pancreas, uterus, ribs, skin, soft palate and Waldeyer ring. After reduction of immunosuppression intensity, 3 cases received surgical therapy, 6 cases with chemotherapy, 1 case with surgery combined with chemotherapy, 1 case with chemotherapy combined with irradiation and 1 case without treatment. The overall response rate was 81.8%, including 8 cases with CR, 1 with PR and 2 with progression. During a median of 11.5 （range： 1 to 130） months follow-up, 3 patients died. Conclusion NHL was a rare but serious complication after renal transplantation occurred with bimodal distribution, which was symptomatic diversity and non-specificity. The most histopathological type was DLBCL. Reduction of immunosuppression intensity was not enough to get efficacy, and CHOP with or without rituximab was effective in the treatment of NHL after renal transplantation.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2013年第11期957-961,共5页
Chinese Journal of Hematology
关键词
肾移植
淋巴瘤
非霍奇金
免疫抑制剂
Kidney transplantation
Lymphoma, non-Hodgkin
Immunosuppression
