Ambinder R F
Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21087, USA.
Bone Marrow Transplant. 2009 Jul;44(1):1-5. doi: 10.1038/bmt.2009.105. Epub 2009 May 18.
In an earlier era, high-dose therapies were thought to be contraindicated in HIV-infected patients. Patients with HIV fared somewhat better with reduced-dose lymphoma therapies and salvage of relapsed patients was rarely possible. With more than a decade of effective antiretroviral therapy, full-dose lymphoma therapies have become standard, and high-dose therapy with autologous hematopoietic stem cell rescue for those who fail frontline therapy or who are judged to have very high risk disease has been pursued with very encouraging results. Transplant-related mortality is less than 5%. With prophylaxis for pneumocystis and herpesvirus infections, deaths due to opportunistic infections are distinctly unusual. Most deaths have been associated with veno-occlusive disease or lymphoma progression. There is no need for quarantine of patients or special isolation procedures. Most patients with responsive lymphoma remain lymphoma free several years after high-dose therapy. CD4(+) cell count and HIV load seem not to be adversely affected in the long term. Much like diabetes, HIV infection should be regarded as a problem that requires special attention during high-dose therapy rather than a contraindication to high-dose therapy in patients with lymphoma who would otherwise be judged transplant candidates.
在更早的时代，高剂量疗法被认为对HIV感染患者是禁忌的。HIV感染患者采用低剂量淋巴瘤疗法的情况稍好一些，而复发性患者很少能够挽救。随着十多年有效的抗逆转录病毒治疗，全剂量淋巴瘤疗法已成为标准，对于一线治疗失败或被判定患有极高风险疾病的患者，采用自体造血干细胞救援的高剂量疗法已经取得了非常令人鼓舞的结果。移植相关死亡率低于5%。通过预防肺孢子菌和疱疹病毒感染，因机会性感染导致的死亡非常罕见。大多数死亡与静脉闭塞性疾病或淋巴瘤进展有关。无需对患者进行隔离或采取特殊的隔离程序。大多数对淋巴瘤有反应的患者在高剂量治疗后数年仍无淋巴瘤。从长期来看，CD4(+)细胞计数和HIV载量似乎没有受到不利影响。与糖尿病很相似，HIV感染应被视为在高剂量治疗期间需要特别关注的问题，而不是对那些原本被判定为移植候选者的淋巴瘤患者进行高剂量治疗的禁忌证。
