造血干细胞移植后淋巴细胞增殖性疾病1例报道并文献复习

目的提高对移植后淋巴细胞增殖性疾病（PTLD）的认识。方法报道1例淋巴瘤白血病患者在Bu/Cy/ATG方案预处理后行无关供者异基因外周血造血干细胞移植。结果移植后3个月发生PTLD,经及时给予免疫抑制剂减量、美罗华及抗病毒治疗后,患者病情好转,但最终因合并严重肺部感染、病情加重放弃治疗。结论PTLD是造血干细胞和实体器官移植后的一种少见但致命的并发症,如有可疑PTLD应尽早行局部淋巴结病理组织活检、EBV定量PCR血清检测或病理组织EBV-DNA检测,及早诊断,及时治疗。

Lymphoproliferative disorder after allogeneic hematopoietic stem cell transplantation:A case report and review of the literature

Objective To study the early diagnosis and treatment of lymphoproliferative disorder （PTLD） in a male patient after hematopoietic stem cell transplantation（HSCT）. Methods A case of lymphoma and leukemia was reported, who underwent transplantation of allogeneic hematopoietic stem cells （HSC） from peripheral blood of unrelated donors after pretreatment with bulsulfan/cyclophosphomide/antithymocyte globulin （Bu/Cy/ATG）. Results Ninety-four days after HSCT, he developed PTLD. After treatment with tacrolimus （FK506）, rituximab, prednisolone and acyclovir, his condition was improved. However, he died of serious lung infection at last. Conclusion PTLD is a rare and fatal complication of solid organ and hematopoietic stem cell transplantation. Lymph node biopsy, quantitative PCR and pathology should be performed for the detection of EBV and EBV DNA if PTLD is suspected so that it can be diagnosed and treated at its early stage.