Hematology Section, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Ann Hematol. 2010 Jan;89(1):45-51. doi: 10.1007/s00277-009-0761-3. Epub 2009 Jun 4.
The aim of this study was to evaluate a prognostic score for aids-related lymphoma (ARL). A retrospective study of 104 patients with ARL treated between January 1999 and December 2007 was conducted. Diffuse large B-cell lymphoma (DLBC) was the most observed histological type (79.8%). The median CD4 lymphocyte count at lymphoma diagnosis was 125 cells per microliter. Treatment response could be evaluated in 83 (79.8%) patients, and 38 (45.8%) reached complete remission (CR); overall response rate was 51.8% (95 CI = 38.5-65.1%). After a median follow-up of 48 months, the 4-year overall survival (OS) rate among all patients was 35.8%, with a median survival time of 9.7 months (95% CI = 5.5-13.9 months). The survival risk factors observed in multivariate analysis (previous AIDS and high-intermediate/high international prognostic index (IPI)) were combined to construct a risk score, which divided the whole patient population in three distinct groups as low, intermediate, and high risk. When this score was applied to DLBC patients, a clear distinction in response rates and in OS could be demonstrated. Median disease-free survival (DFS) for patients that achieved CR was not reached, and DFS in 4 years was 83.0%. Our results show that the reduced OS observed could be explained by poor immune status with advanced stage of disease seen in our population of HIV-positive patients. Further studies will be needed to clarify the role of different treatment approaches for ARL in the setting of marked immunosuppression and to identify a group of patients to whom intensive therapy could be performed with a curative intent.
本研究旨在评估艾滋病相关淋巴瘤（ARL）的预后评分。回顾性分析了 104 例 1999 年 1 月至 2007 年 12 月期间治疗的 ARL 患者。弥漫性大 B 细胞淋巴瘤（DLBC）是最常见的组织学类型（79.8%）。淋巴瘤诊断时的中位 CD4 淋巴细胞计数为 125 个/微升。可评估 83 例（79.8%）患者的治疗反应，38 例（45.8%）达到完全缓解（CR）；总缓解率为 51.8%（95%CI=38.5-65.1%）。中位随访 48 个月后，所有患者的 4 年总生存率（OS）为 35.8%，中位生存时间为 9.7 个月（95%CI=5.5-13.9 个月）。多因素分析观察到的生存危险因素（既往 AIDS 和高-中/高国际预后指数（IPI））被组合起来构建风险评分，将整个患者人群分为低、中、高风险三组。当该评分应用于 DLBC 患者时，可以明显区分反应率和 OS。达到 CR 的患者的中位无疾病生存（DFS）未达到，4 年的 DFS 为 83.0%。我们的结果表明，我们的 HIV 阳性患者群体中，免疫状态差且疾病处于晚期导致观察到的 OS 降低。需要进一步研究来阐明在明显免疫抑制的情况下，不同治疗方法在 ARL 中的作用，并确定一组可进行强化治疗以达到治愈目的的患者。
