Clinical Analysis Of Post-transplant Lymphoproliferative Disorders After Allogeneic Peripheral Blood Stem Cell Transplantation

Background:lymphocytic proliferative disease(PTLD)is a rare complication after hematopoietic stem cell transplantation.There is not much literature reported.The incidence of recent clinical events is increasing.Clinicians have not reached a consensus on the understanding and treatment of the disease.Objective:Based on statistics of clinical data of transplant patients in recent 3 years,combined with the research progress worldwide,we tried to study the clinical epidemiological characteristics,diagnosis and prognosis of PTLD after allogeneic peripheral blood stem cell transplantation.So as to improve the understanding and diagnosis and treatment of PTLD after allo-HSCT.Methods:The clinical data of 244 patients receiving allogeneic peripheral blood stem cell transplantation in General Hospital of PLA in April-2017 May 2014 were statistically analyzed,including gender,age,type of disease,transplantation,donor compliance,blood hematopoietic reconstruction scheme,pretreatment time,whether with GVHD or EB virus infection,diagnosis and choice of treatment the condition of patients with PTLD,and to evaluate the effect of follow-up time.SPSS software was used for statistical analysis.To sum up the incidence,risk factors,treatment and survival of PTLD in the transplant population.Results:Of the 244 Cases of transplantation,22 cases of PTLD were found,the incidence of which was 9.02%.The incidence of the 3 year was 4.4%(3/68),6.8%(6/88)and 14.8%(13/88)separately.The gender,age,type of disease,type of transplantation,whether the donor's blood type is consistent,the use of ATG,GVHD,whether the presence of EB virus infection and other factors were analyzed,single factor analysis showed that the primary disease types,the type of transplantation,whether the use of ATG,whether the EB virus infection and transplantation the incidence of PTLD associated with.There is no correlation between sex,age,whether the donor's blood type is consistent,whether the occurrence of GVHD and the incidence of PTLD after transplantation.Of the 22 patients with PTLD,17 were diagnosed with EB viremia combined with a typical clinical manifestation,and 5 cases were confirmed by biopsy.20 cases were treated with rituximab or rituximab based combination therapy,17 cases were effective,and the effective rate was 85%.The median follow-up time was 122 days,the median survival time was 5(1-22)months and the total survival rate was 50%.Conclusion:The incidence of PTLD is increasing year by year after.The incidence is closely related to EB virus infection.ATG is a high risk factor for PTLD in haploidentical hematopoietic stem cell transplantation.In the case of no pathological diagnosis,clinical and laboratory examinations should be actively combined with clinical diagnosis.Rituximab is safe and effective in the treatment of PTLD,and has gradually been recognized by clinicians.Early diagnosis and early treatment can improve the poor prognosis of PTLD.