タナカ ジユンジ   TANAKA Junji
  田中 淳司
   所属   医学部 医学科(東京女子医科大学病院)
   職種   教授・基幹分野長
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Risk Factors and Predictive Scoring System For Post-Transplant Lymphoproliferative Disorder after Hematopoietic Stem Cell Transplantation.
掲載誌名 正式名:Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
略  称:Biol Blood Marrow Transplant
ISSNコード:(1523-6536)1083-8791(Linking)
掲載区分国外
巻・号・頁 25(7),pp.1441-1449
著者・共著者 Fujimoto Ayumi†, Hiramoto Nobuhiro, Yamasaki Satoshi, Inamoto Yoshihiro, Uchida Naoyuki, Maeda Tetsuo, Mori Takehiko, Kanda Yoshinobu, Kondo Tadakazu, Shiratori Souichi, Miyakoshi Shigesaburo, Ishiyama Ken, Ikegame Kazuhiro, Matsuhashi Yoshiko, Tanaka Junji, Ichinohe Tatsuo, Atsuta Yoshiko, Ogata Masao, Suzuki Ritsuro
発行年月 2019/07
概要 We analyzed data from 64,539 consecutive patients in the Japanese national transplant registry, including 40,195 after allogeneic hematopoietic stem cell transplantation (HSCT), 24,215 after autologous HSCT and 129 after syngeneic HSCT, of whom 299 developed Epstein-Barr virus-positive post-transplant lymphoproliferative disorder (PTLD). The probability of developing PTLD at 2years post-HSCT was .79% after allogeneic transplantation, .78% after syngeneic transplantation, and .11% after autologous transplantation. The following variables were identified as risk factors after allogeneic HSCT in multivariate analysis: antithymocyte globulin (ATG) use in a conditioning regimen, ATG use for acute graft-versus-host disease (GVHD) treatment, donor other than an HLA-matched related donor, aplastic anemia, second or subsequent allogeneic HSCT, the most recent year of transplantation, and acute GVHD. The probability at 2years increased particularly after 2009 (1.24%) than before 2009 (.45%). To stratify the risk of PTLD before allogeneic HSCT, we developed a novel 5-point scoring system based on 3 pretransplant risk factors: ATG use in a conditioning regimen (high dose, 2 points; low dose, 1 point), donor type (HLA-mismatched related donor, 1 point; unrelated donor, 1 point; cord blood, 2 points), and aplastic anemia (1 point). Patients were classified into 4 risk groups according to the summed points: low risk (0 or 1 point), intermediate risk (2 points), high risk (3 points), and very high risk (4 or 5 points) groups, with probabilities at 2years of .3%, 1.3%, 4.6%, and 11.5%, respectively. Our scoring system is useful for predicting patients at high risk for PTLD. Careful observation and close monitoring of Epstein-Barr virus reactivation are warranted for these high-risk patients.
DOI 10.1016/j.bbmt.2019.02.016
PMID 30794929