获得性免疫缺陷综合征相关淋巴瘤：环磷酰胺、阿霉素、长春新碱和强的松联合化疗与高效抗逆转录病毒疗法同时治疗是安全的且可提高生存率——德国多中心试验结果

Acquired immunodeficiency syndrome-related lymphoma: simultaneous treatment with combined cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy and highly active antiretroviral therapy is safe and improves survival--results of the German Multicenter Trial.

作者信息

Weiss Rudolf, Mitrou Paris, Arasteh Keikawus, Schuermann Dirk, Hentrich Marcus, Duehrsen Ulrich, Sudeck Hinrich, Schmidt-Wolf Ingo G H, Anagnostopoulos Ioannis, Huhn Dieter

机构信息

Private Practice for Hematology, Oncology and Infectious Diseases, Bremen, Germany.

出版信息

Cancer. 2006 Apr 1;106(7):1560-8. doi: 10.1002/cncr.21759.

DOI:10.1002/cncr.21759

PMID:16502436

Abstract

BACKGROUND

Highly active antiretroviral therapy (HAART) has improved the survival of patients with acquired immunodeficiency syndrome-related lymphoma (ARL). The German ARL Study Group investigated whether HAART administered concomitantly with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy compromised the course of immune parameters during and after chemotherapy and exerted a positive effect on remission and survival.

METHODS

From 1997 to 2001, 72 patients with ARL were stratified prospectively into a standard-risk group (n = 48 patients) and a high-risk group (n = 24 patients) with either 0-1 or 2-3 of the following risk factors: CD4 < 50/microL, prior opportunistic infection, and/or a World Health Organization performance status > or = 3. Patients in the high-risk group received > or =75% of the CHOP regimen.

RESULTS

In the standard-risk group (CD4 = 223/muL; age-adjusted International Prognostic Index [aaIPI], 38% > or = 2), the complete remission (CR) rate was 79%, and median survival was not reached after a median 47 months of follow-up. CD4 counts did not change from baseline to 4 weeks after the end of chemotherapy (206/microL). In the high-risk group (CD4 = 34/muL; aaIPI, 88% > or = 2), the CR rate was 29%, and the median survival was 7.2 months (3 patients survived for > 3 yrs). Toxicity was moderate: Leukopenia Grade 3 or 4 occurred in 100 of 249 chemotherapy cycles (40%) in the standard-risk group and in 70 of 102 cycles (69%) in the high-risk group.

CONCLUSIONS

Based on the aaIPI, the survival of patients in the standard-risk group was very similar to that achieved by nonhuman immunodeficiency virus-infected patients who had aggressive lymphomas. Concurrent CHOP plus HAART can be administered in an outpatient setting. Thus, the authors recommend using this modality as first-line therapy for patients with ARL.

摘要

背景

高效抗逆转录病毒疗法（HAART）提高了获得性免疫缺陷综合征相关淋巴瘤（ARL）患者的生存率。德国ARL研究小组调查了HAART与环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）化疗同时使用是否会影响化疗期间及化疗后的免疫参数进程，并对缓解率和生存率产生积极影响。

方法

1997年至2001年，72例ARL患者被前瞻性地分为标准风险组（n = 48例患者）和高风险组（n = 24例患者），根据以下0 - 1个或2 - 3个风险因素进行分层：CD4 < 50/μL、既往机会性感染和/或世界卫生组织体能状态≥3。高风险组患者接受≥75%的CHOP方案。

结果

在标准风险组（CD4 = 223/μL；年龄调整国际预后指数[aaIPI]，38%≥2）中，完全缓解（CR）率为79%，中位随访47个月后未达到中位生存期。从基线到化疗结束后4周，CD4计数没有变化（206/μL）。在高风险组（CD4 = 34/μL；aaIPI，88%≥2）中，CR率为29%，中位生存期为7.2个月（3例患者存活超过3年）。毒性为中度：标准风险组249个化疗周期中有100个（40%）发生3或4级白细胞减少，高风险组102个周期中有70个（69%）发生。