Department of Medical Oncology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian, People's Republic of China.
Ann Hematol. 2012 Nov;91(11):1757-63. doi: 10.1007/s00277-012-1518-y. Epub 2012 Jul 13.
Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. Even though NHL is commonly chemosensitive to primary treatment, failure or relapse still occurs in a large number of patients. We conducted this retrospective study to evaluate the efficacy and safety of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory AIDS-related NHL (AIDS-NHL). Forty-eight patients with relapsed or refractory AIDS-NHL were treated with intravenous combination chemotherapy with GDP. The overall objective response rate was 54.1% (95% confidence interval, CI, 40.1-68.3%), with 10 complete responses and 16 partial responses. The 2-year overall survival rate (OS) was 70.8% (95% CI 58.0-83.7%), and the 5-year OS was 41.7% (95% CI 27.7-55.6%). The 2-year progression-free survival rate (PFS) was 37.5% (95% CI 23.8-51.2%), and the 5-year PFS was 25.0% (95% CI 12.8-37.3%). The median progression-free survival was 8.8 months (95% CI 0-20.3 months), and the median overall survival was 40.6 months (95% CI 22.6-58.6 months). Patients with B cell tumors who relapsed but had no B symptoms were clinical stage I/II, had infiltration fewer than two extranodal sites, had CD4⁺ counts >200 cells/μL, and had lactate dehydrogenase (LDH) less than the upper limit of normal benefited from GDP. The level of LDH had a significant impact on the response rate to chemotherapy with GDP (P = 0.015). Myelosuppression was the main side effect; the incidence of grade 3-4 anemia was 8.3%; leukopenia, 37.5%; and thrombocytopenia, 48.3%. Univariate and multivariate analyses were performed to determine variables for OS and PFS. This study confirms that GDP is an effective and safe salvage regimen in relapsed or refractory AIDS-NHL, was associated with modest declines in CD4⁺ lymphocyte counts, and did not promote HIV-1 viral replication.
非霍奇金淋巴瘤（NHL）仍然是人类免疫缺陷病毒（HIV）感染患者第二常见的恶性并发症。尽管 NHL 对初始治疗通常具有化疗敏感性，但仍有大量患者发生治疗失败或复发。我们进行了这项回顾性研究，以评估吉西他滨、地塞米松和顺铂（GDP）治疗复发或难治性艾滋病相关 NHL（AIDS-NHL）的疗效和安全性。48 例复发或难治性 AIDS-NHL 患者接受 GDP 静脉联合化疗。总客观缓解率为 54.1%（95%置信区间，CI，40.1-68.3%），完全缓解 10 例，部分缓解 16 例。2 年总生存率（OS）为 70.8%（95%CI，58.0-83.7%），5 年 OS 为 41.7%（95%CI，27.7-55.6%）。2 年无进展生存率（PFS）为 37.5%（95%CI，23.8-51.2%），5 年 PFS 为 25.0%（95%CI，12.8-37.3%）。中位无进展生存期为 8.8 个月（95%CI，0-20.3 个月），中位总生存期为 40.6 个月（95%CI，22.6-58.6 个月）。复发但无 B 症状的 B 细胞肿瘤患者为临床 I/II 期，受累结外部位少于 2 个，CD4⁺计数>200 个/μL，乳酸脱氢酶（LDH）低于正常值上限，从 GDP 中获益。LDH 水平对 GDP 化疗的缓解率有显著影响（P=0.015）。骨髓抑制是主要的副作用；3-4 级贫血发生率为 8.3%；白细胞减少症发生率为 37.5%；血小板减少症发生率为 48.3%。进行了单变量和多变量分析以确定 OS 和 PFS 的变量。这项研究证实，GDP 是复发或难治性 AIDS-NHL 的一种有效且安全的挽救方案，与 CD4⁺淋巴细胞计数适度下降相关，不会促进 HIV-1 病毒复制。
