Navarro J T, Ribera J M, Oriol A, Vaquero M, Romeu J, Batlle M, Flores A, Millá F, Feliu E
Department of Haematology-Haemotherapy, Hospital Germans Trias i Pujol, C/Canyet s/n, 08916 Badalona, Universitat Autònoma de Barcelona, Spain.
Br J Haematol. 2001 Mar;112(4):909-15. doi: 10.1046/j.1365-2141.2001.02656.x.
Combined highly active anti-retroviral therapy (HAART) with protease and reverse transcriptase inhibitors has modified the natural history of opportunistic infections and neoplasms in human immunodeficiency virus (HIV)-infected patients. We analysed the influence of HAART on the response to treatment and survival in a series of 58 patients with acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) treated with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone). Two groups of patients were included: (i) forty-one patients diagnosed with NHL between 1988 and 1996 who were not treated with HAART; (ii) seventeen patients diagnosed since 1996, who were receiving or commenced HAART when NHL was diagnosed. The response rate to CHOP was higher in group 2 (13 out of 17 cases; 75%) than in group 1 (14 out of 41 cases; 34%) (P = 0.003). The 2-year probability of event-free survival (EFS) [95% confidence interval (CI)] for group 1 was 0.5 (0.24-0.74), whereas for group 2 it was 0.85 (0.61-0.90) (P = 0.024). The lymphoma-free survival (LFS) was also significantly different for both groups (2-year LFS probability 0.53 vs. 1.0, P = 0.04). The median (95% CI) overall survival (OS) for group 1 was 7 months (range, 3-10.8 months), whereas it was not reached in group 2 (P = 0.0015). In the multivariate analysis for remission attainment, the only variables with a higher probability to achieve complete remission (CR) were HAART (P = 0.01) and International Prognostic Index score 1 (P = 0.02). The only statistically significant variable in the multivariate analysis for EFS was HAART (P = 0.049) and the variables with prognostic value for OS in the multivariate analysis were B symptoms (P = 0.01) and HAART (P = 0.003). Patients with AIDS-related NHL treated with CHOP and HAART had a higher CR rate than those treated only with CHOP. In this study, HAART was an independent prognostic factor for CR, OS and EFS in patients with AIDS-related NHL.
联合使用蛋白酶抑制剂和逆转录酶抑制剂的高效抗逆转录病毒疗法（HAART）改变了人类免疫缺陷病毒（HIV）感染患者机会性感染和肿瘤的自然病程。我们分析了HAART对58例接受CHOP（环磷酰胺、羟基柔红霉素、长春新碱和泼尼松）治疗的获得性免疫缺陷综合征（AIDS）相关非霍奇金淋巴瘤（NHL）患者治疗反应和生存的影响。纳入两组患者：（i）1988年至1996年间诊断为NHL且未接受HAART治疗的41例患者；（ii）1996年以来诊断的17例患者，这些患者在诊断NHL时正在接受或开始接受HAART治疗。第2组对CHOP的反应率（17例中的13例；75%）高于第1组（41例中的14例；34%）（P = 0.003）。第1组的2年无事件生存率（EFS）[95%置信区间（CI）]为0.5（0.24 - 0.74），而第2组为0.85（0.61 - 0.90）（P = 0.024）。两组的无淋巴瘤生存率（LFS）也有显著差异（2年LFS概率0.53对1.0，P = 0.04）。第1组的中位（95%CI）总生存期（OS）为7个月（范围3 - 10.8个月），而第2组未达到（P = 0.0015）。在缓解达成的多变量分析中，达到完全缓解（CR）概率较高的唯一变量是HAART（P = 0.01）和国际预后指数评分为1（P = 0.02）。EFS多变量分析中唯一具有统计学意义的变量是HAART（P = 0.049），OS多变量分析中具有预后价值的变量是B症状（P = 0.01）和HAART（P = 0.003）。接受CHOP和HAART治疗的AIDS相关NHL患者的CR率高于仅接受CHOP治疗的患者。在本研究中，HAART是AIDS相关NHL患者CR、OS和EFS的独立预后因素。
