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对于接受CHOP方案及高效抗逆转录病毒治疗的系统性获得性免疫缺陷综合征相关非霍奇金淋巴瘤患者,疾病晚期是影响生存的最重要预后因素。

Advanced stage is the most important prognostic factor for survival in patients with systemic acquired immunodeficiency syndrome-related non-Hodgkin's Lymphoma treated with CHOP and highly active antiretroviral therapy.

作者信息

Navarro José-Tomás, Ribera Josep-Maria, Oriol Albert, Xicoy Blanca, Mate José-Luis, Sirera Guillem, Lloveras Natalia, Millá Fuensanta, Feliu Evarist

机构信息

Department of Hematology, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona.

出版信息

Int J Hematol. 2007 Nov;86(4):337-42. doi: 10.1532/IJH97.E0636.

Abstract

In the era of highly active antiretroviral therapy (HAART), the prognosis for acquired immunodeficiency syndrome-related lymphomas (ARL) seems to be similar to that for aggressive B-cell lymphomas in human immunodeficiency virus (HIV)-negative patients. This improvement in prognosis might lead to a modification of the classic prognostic factors for ARL. We evaluated the prognostic factors for response and survival in a series of HIV-infected patients with systemic non-Hodgkin's lymphoma (NHL) in the HAART era. Forty patients with systemic NHL treated with a CHOP-based chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) and HAART were studied. The main clinicopathologic and laboratory parameters were recorded in each case. Patients were scheduled to receive cycles of CHOP therapy, and all received granulocyte colony-stimulating factor. In addition, 9 patients received rituximab (375 mg/m2). The complete remission (CR) rate was 62.5% (n = 25). No prognostic factors influencing CR attainment were found. The 5-year disease-free survival (DFS) probability (95% confidence interval [CI]) was 73% (54%-92%). The median overall survival (OS) time was 69.17 months, and the 5-year OS rate (95% CI) was 51% (35%-67%). A disease stage of III to IV was the only parameter with prognostic influence on DFS. The factors influencing OS were an International Prognostic Index >2, an Eastern Cooperative Ecology Group (ECOG) score >2, and a disease stage of III to IV. Patients with an advanced stage had a lower OS probability in a multivariate analysis (odds ratio, 4.24; 95% CI, 1.24- 14.57). Advanced stage was the main prognostic factor predicting survival in ARL treated with CHOP and HAART.

摘要

在高效抗逆转录病毒治疗(HAART)时代,获得性免疫缺陷综合征相关淋巴瘤(ARL)的预后似乎与人类免疫缺陷病毒(HIV)阴性患者侵袭性B细胞淋巴瘤的预后相似。预后的这种改善可能会导致ARL经典预后因素的改变。我们评估了HAART时代一系列HIV感染的系统性非霍奇金淋巴瘤(NHL)患者的反应和生存预后因素。研究了40例接受基于CHOP(环磷酰胺、阿霉素、长春新碱和泼尼松)化疗及HAART治疗的系统性NHL患者。记录了每例患者的主要临床病理和实验室参数。患者按计划接受CHOP治疗周期,均接受粒细胞集落刺激因子治疗。此外,9例患者接受了利妥昔单抗(375mg/m²)治疗。完全缓解(CR)率为62.5%(n = 25)。未发现影响达到CR的预后因素。5年无病生存(DFS)概率(95%置信区间[CI])为73%(54%-92%)。总生存(OS)时间中位数为69.17个月,5年OS率(95%CI)为51%(35%-67%)。III至IV期疾病是唯一对DFS有预后影响的参数。影响OS的因素为国际预后指数>2、东部肿瘤协作组(ECOG)评分>2以及III至IV期疾病。在多因素分析中,晚期患者的OS概率较低(比值比,4.24;95%CI,1.24 - 14.57)。晚期是接受CHOP和HAART治疗的ARL患者生存的主要预后因素。

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