Williamson Bradley T, Leitch Heather A
Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada V6Z 2A5.
Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada V6Z 2A5.
Case Rep Hematol. 2016;2016:8502641. doi: 10.1155/2016/8502641. Epub 2016 Jan 20.
Introduction. In advanced HIV prior to combination antiretroviral therapy (ART), dysplastic marrow changes occurred and resolved with ART. Few reports of myelodysplastic syndromes (MDS) in well-controlled HIV exist and management is undefined. Methods. Patients with well-controlled HIV and higher risk MDS were identified; characteristics, treatment, and outcomes were reviewed. Results. Of 292 MDS patients since 1996, 1 (0.3%) was HIV-positive. A 56-year-old woman presented with cytopenias. CD4 was 1310 cells/mL and HIV viral load <40 copies/mL. Bone marrow biopsy showed RCMD and karyotype included del(5q) and del(7q); IPSS was intermediate-2 risk. She received azacitidine at 75% dose. Cycle 2, at full dose, was complicated by marrow aplasia and possible AML; she elected palliation. Three additional HIV patients with higher risk MDS, aged 56-64, were identified from the literature. All had deletions involving chromosomes 5 and 7. MDS treatment of 2 was not reported and one received palliation; all died of AML. Conclusion. Four higher risk MDS in well-controlled HIV were below the median age of diagnosis for HIV-negative patients; all had adverse karyotype. This is the first report of an HIV patient receiving MDS treatment with azacitidine. Cytopenias were profound and dosing in HIV patients should be considered with caution.
引言。在联合抗逆转录病毒治疗（ART）之前的晚期HIV患者中，会出现发育异常的骨髓改变，且这些改变会随着ART而消退。关于病情得到良好控制的HIV患者发生骨髓增生异常综合征（MDS）的报道很少，且治疗方法尚不明确。方法。确定病情得到良好控制且患有高风险MDS的患者；回顾其特征、治疗及预后情况。结果。自1996年以来的292例MDS患者中，1例（0.3%）为HIV阳性。一名56岁女性出现血细胞减少。CD4细胞计数为1310个/毫升，HIV病毒载量<40拷贝/毫升。骨髓活检显示为RCMD，核型包括del(5q)和del(7q)；国际预后评分系统（IPSS）为中-2级风险。她接受了75%剂量的阿扎胞苷治疗。第2周期采用全剂量治疗时，出现了骨髓再生障碍并可能发展为急性髓系白血病（AML）；她选择了姑息治疗。从文献中又确定了另外3例年龄在56 - 64岁、患有高风险MDS的HIV患者。所有患者均有涉及5号和7号染色体的缺失。2例患者的MDS治疗情况未报道，1例接受了姑息治疗；所有患者均死于AML。结论。4例病情得到良好控制的HIV患者所患的高风险MDS，其诊断年龄低于HIV阴性患者的诊断年龄中位数；所有患者均有不良核型。这是关于一名HIV患者接受阿扎胞苷治疗MDS的首例报告。血细胞减少情况严重，对HIV患者用药时应谨慎考虑剂量。
