在南非推出联合抗逆转录病毒疗法的背景下，艾滋病相关弥漫性大 B 细胞淋巴瘤的治疗结果。
Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa.
机构信息
Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa, USA.
出版信息
J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):66-73. doi: 10.1097/QAI.0b013e3182a03e9b.
BACKGROUND
Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown.
METHODS
We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated.
RESULTS
Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87).
CONCLUSIONS
Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.
背景
在有可用的联合抗逆转录病毒疗法（cART）的情况下，艾滋病相关弥漫性大 B 细胞淋巴瘤（DLBCL）患者的长期生存是可行的。然而，鉴于肿瘤学资源有限，南非艾滋病相关 DLBCL 的结局尚不清楚。
方法
我们对在南非开普敦的一家三级教学医院接受新诊断的艾滋病相关 DLBCL 治疗的患者进行了生存回顾性分析，治疗方案为环磷酰胺、多柔比星、长春新碱和口服泼尼松（CHOP）或 CHOP 样化疗（2004 年 1 月至 2010 年 12 月）。评估了与 HIV 相关和淋巴瘤相关的预后因素。
结果
共评估了 36 例患者；中位年龄为 37.3 岁，52.8%为男性，61.1%为南非黑人。中位 CD4 计数为每微升 184 个细胞（在 27.8%的患者中，这一数值<100 个/μL），80%的患者根据年龄调整后的国际预后指数（IPI）属于高危。25%的患者合并有结核分枝杆菌。2 年总生存率（OS）为 40.5%（中位 OS 为 10.5 个月，95%置信区间：6.5 至 31.8）。东部肿瘤协作组（ECOG）表现状态为 2 或更高（25.4%与 50.0%，P=0.01）和对 cART 的不良反应（18.0%与 53.9%，P=0.03）预测 2 年 OS 较差。在合并结核分枝杆菌感染的患者中，2 年 OS 无差异（P=0.87）。
结论
接受 CHOP 样方案和 cART 治疗的艾滋病相关 DLBCL 患者的 2 年 OS 与美国和欧洲的相似。影响南非艾滋病相关 DLBCL 患者 OS 的重要因素包括就诊时的表现状态和对 cART 的反应。在我们的环境中，合并结核分枝杆菌或乙型肝炎病毒血清阳性的患者似乎可以耐受 CHOP。可能会有更多的生存获益。
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