NAGAI Yuya, MORI Minako, INOUE Daichi, KIMURA Takaharu, SHIMOJI Sonoko, TOGAMI Katsuhiro, TABATA Sumie, MATSUSHITA Akiko, NAGAI Kenichi, Imai Yukihiro, Takafuta Toshiro, Takahashi Takayuki
Departments of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital.
Rinsho Ketsueki. 2009 Nov;50(11):1641-6.
A 62-year-old man was diagnosed with human immunodeficiency virus (HIV) infection while suffering from recurrent herpes zoster infection. Laboratory examination revealed CD4(+) lymphocyte count 16 cells/mul and HIV loading 150,000 copies/ml at presentation. In addition, he had multiple lymph node swelling. Histologic diagnosis of a biopsied lymph node was diffuse, large, B cell-type malignant lymphoma. The karyotype of the lymphoma cells was t(8;14)(q24;q32), which was confirmed by G-banding and fluorescent in situ hybridization. Positron emission tomography (PET)-combined CT scanning revealed systemic extranodal tumors involving the gastrointestinal tract, pancreas, and bone marrow. The clinical stage of the lymphoma was IVB and the international prognosis index was categorized as high. Complete remission (CR) of the lymphoma was obtained after 2 courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy and 4 subsequent courses of rituximab-combined CHOP (R-CHOP). Highly active antiretroviral therapy (HAART) was started at the initiation of CHOP. Because of the poor prognosis of AIDS-related lymphoma, he received autologous peripheral blood stem cell transplantation with the MEAM protocol (ranimustine, etoposide, cytarabine, melphalan) as a conditioning procedure without a severe infectious episode. He remains in CR 24 months after the transplantation.
一名62岁男性在患有复发性带状疱疹感染时被诊断出感染人类免疫缺陷病毒（HIV）。实验室检查显示，初诊时CD4(+)淋巴细胞计数为16个/微升，HIV载量为150,000拷贝/毫升。此外，他有多处淋巴结肿大。对一个活检淋巴结的组织学诊断为弥漫性大B细胞型恶性淋巴瘤。淋巴瘤细胞的核型为t(8;14)(q24;q32)，经G显带和荧光原位杂交证实。正电子发射断层扫描（PET）联合CT扫描显示全身结外肿瘤累及胃肠道、胰腺和骨髓。淋巴瘤的临床分期为IVB期，国际预后指数分类为高危。在接受2个疗程的CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松龙）化疗以及随后4个疗程的利妥昔单抗联合CHOP（R-CHOP）化疗后，淋巴瘤获得完全缓解（CR）。在开始CHOP化疗时启动了高效抗逆转录病毒治疗（HAART）。由于艾滋病相关淋巴瘤预后较差，他接受了采用MEAM方案（司莫司汀、依托泊苷、阿糖胞苷、美法仑）的自体外周血干细胞移植作为预处理程序，且未发生严重感染事件。移植后24个月他仍处于完全缓解状态。
