Gopal Satish, Fedoriw Yuri, Kaimila Bongani, Montgomery Nathan D, Kasonkanji Edwards, Moses Agnes, Nyasosela Richard, Mzumara Suzgo, Varela Carlos, Chikasema Maria, Makwakwa Victor, Itimu Salama, Tomoka Tamiwe, Kamiza Steve, Dhungel Bal M, Chimzimu Fred, Kampani Coxcilly, Krysiak Robert, Richards Kristy L, Shea Thomas C, Liomba N George
UNC Project-Malawi, Lilongwe, Malawi.
Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America.
PLoS One. 2016 Mar 2;11(3):e0150445. doi: 10.1371/journal.pone.0150445. eCollection 2016.
There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39-56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥ 2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1-31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61-244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31-57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p<0.001) were associated with mortality. HIV was not associated with mortality, and findings were similar among patients with diffuse large B-cell lymphoma. Twenty-three deaths were from NHL (12 HIV+, 11 HIV-), and 12 from CHOP (9 HIV+, 3 HIV-). CHOP can be safe, effective, and feasible for aggressive NHL in Malawi with and without HIV.
在撒哈拉以南非洲地区，尚无关于采用CHOP方案治疗侵袭性非霍奇金淋巴瘤（NHL）的前瞻性研究。我们于2013年6月至2015年5月在马拉维招募了患有侵袭性NHL的成人患者。化疗和支持治疗均标准化，HIV阳性患者接受抗逆转录病毒治疗（ART）。58例患者中有37例（64%）为HIV阳性。中位年龄为47岁（四分位间距39 - 56岁），35例（60%）为男性。35例患者（60%）处于Ⅲ/Ⅳ期，43例（74%）有B症状，28例（48%）体能状态≥2。HIV阳性患者中B细胞NHL占主导，所有T细胞NHL均发生在HIV阴性个体中。31例HIV阳性患者（84%）在NHL诊断前接受ART治疗的中位时间为9.9个月（四分位间距1.1 - 31.7个月），中位CD4细胞计数为121个/μL（四分位间距61 - 244个/μL），43%的患者HIV RNA得到抑制。与HIV阴性患者相比，HIV阳性患者接受的CHOP疗程数相似，但更频繁地发生3/4级中性粒细胞减少（84%对31%，p = 0.001），导致环磷酰胺和阿霉素剂量略有降低，疗程间隔延长。12个月总生存率（OS）为45%（95%可信区间31% - 57%）。T细胞NHL（风险比3.90，p = 0.017）、血红蛋白（每g/dL风险比0.82，p = 0.017）、白蛋白（每g/dL风险比0.57，p = 0.019）和国际预后指数（IPI，每单位风险比2.02，p<0.001）与死亡率相关。HIV与死亡率无关，在弥漫性大B细胞淋巴瘤患者中的结果相似。23例死亡由NHL导致（12例HIV阳性，11例HIV阴性），12例由CHOP导致（9例HIV阳性，3例HIV阴性）。对于马拉维有或无HIV感染的侵袭性NHL患者，CHOP方案可能是安全、有效且可行的。
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