治疗多种爱斯坦-巴尔病毒相关的移植后瘤的儿童的结果
Kaitlin J Devine1,2, Alix E Seif1,2, Anne F Reilly1,2
1Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatric transplantation
|July 24, 2023
概括
接受固体器官移植的儿童面临与爱斯坦-巴尔病毒相关的PTLD和光滑肌肉瘤的风险. 可以出现重复发作和新的原发性瘤,需要个性化治疗计划.
科学领域:
- 儿科瘤学 儿科瘤学
- 移植免疫学 移植免疫学
- 病毒学 病毒学
背景情况:
- 经过固体器官移植的儿童容易患上与爱斯坦-巴尔病毒 (EBV) 相关的移植后淋巴增殖障碍 (PTLD) 和光滑肌肉瘤.
- 对于这些复杂病例的临床轨迹,EBV病毒载荷动态以及最佳管理策略的了解有限.
研究的目的:
- 研究经过固体器官移植后经历EBV相关PTLD和光滑肌肉瘤的儿童的临床过程和结果.
- 分析治疗反应,并确定疾病进展的模式.
主要方法:
- 对儿科患者 (21岁以下) 进行了回顾性图表审查,这些患者接受了固体器官移植并发展了PTLD.
- 数据是从2003年1月到2020年6月在费城儿童医院收集的.
主要成果:
- 六名患者经历了与EBV相关的PTLD和光滑肌肉瘤的多次发作. 在四名患者中,组织学差异表明了新的原发性瘤而不是复发.
- 治疗包括病毒特异性T淋巴细胞,修复剂和免疫抑制降低,导致五名患者的完整反应. 三名患者随后发展出瘤,两名患者发展出与EBV相关的光滑肌肉瘤.
- 六名患者中有四人幸存下来,死亡与瘤无关.
结论:
- 儿童在移植后仍然面临复发性EBV相关PTLD和光滑肌肉瘤的风险,即使在初始治疗成功后.
- 随后的病变的独特组织学和位置表明它们可能是第二次原发性恶性瘤.
- 虽然个性化治疗计划显示出希望,但对这些瘤的EBV特异性T细胞疗法的进一步研究是有必要的.
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