在现代联合抗逆转录病毒治疗时代，艾滋病毒相关弥漫性大 B 细胞淋巴瘤的结局。

Outcomes for HIV-associated diffuse large B-cell lymphoma in the modern combined antiretroviral therapy era.

机构信息

aUnit of Hematology-Oncology, Centre Hospitalier de Versailles, Le ChesnaybUniversité Versailles Saint Quentin en Yvelines, Université Paris-Saclay, Communauté Paris-Saclay, PariscINSERM U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Equipe 'Générations et Santé' Gustave Roussy, VillejuifdSorbonne Universités, INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS1136), PariseUniversité Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-BicêtrefPathology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, ClamartgInfectious Diseases Unit, CHU Toulouse, ToulousehInternal Medicine and Infectious Diseases Unit, CHU Bordeaux, INSERM U1219, Université de Bordeaux, BordeauxiInfectious Diseases Unit, AP-HP CHU Saint-Antoine, ParisjHIV Infection Unit, Hôpitaux Universitaires, StrasbourgkU1037, CRCT, University Toulouse III Paul SabatierlDepartment of Hematology, Institut Universitaire du Cancer (IUC), ToulousemDepartment of Hematology, AP-HP, CHU Pitié-Salpétrière, ParisnInternal Medicine Unit, AP-HP, Hôpitaux Paris Sud, Le Kremlin-BicêtreoClinical Immunology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, ClamartpDepartment of Hematology, AP-HP CHU Saint-Antoine, ParisqDepartment of Hematology, AP-HM, Assistance Publique Hôpitaux de Marseille, MarseillerImmunology Unit, AP-HP, Hôpitaux Paris Sud, Le Kremlin-BicêtresDepartment of Hematology, AP-HP, Hôpital Necker Enfants Malades, ParistHematology Unit, Centre Hospitalier Universitaire-Dijon, DijonuDepartment of Onco-Hematology, Archet Hospital, Nice, France.

出版信息

AIDS. 2017 Nov 28;31(18):2493-2501. doi: 10.1097/QAD.0000000000001652.

DOI:10.1097/QAD.0000000000001652

PMID:28926410

Abstract

OBJECTIVE

Non-Hodgkin's lymphoma (NHL) remains among the most frequent malignancies in persons living with HIV (PLWHIV). Survival among patients with HIV-associated diffuse large B-cell lymphoma (DLBCL), the most frequent NHL subtype, has improved markedly in recent years. We aimed to analyze characteristics and outcomes of DLBCL in HIV-infected patients in the era of modern combined antiretroviral therapy (cART).

DESIGN

PLWHIV with lymphoma were prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. We compared the patients treated with R-CHOP) (rituximab, cyclophosphamide, daunorubicin, vin-cristine, prednisolone) with HIV-negative DLBCL patients enrolled simultaneously in the R-CHOP arms of Lymphoma Study Association trials.

RESULTS

Among 110 PLWHIV with NHL, 52 (47%) had systemic DLBCL. These 52 cases had frequent extranodal disease (81%), poor performance status (35%) and advanced age-adjusted international prognostic index (aaIPI) (58%), and were mainly treated with R-CHOP (n = 44, 85%). Their median CD4 T-cell count was 233 cells/μl, and 79% of patients were on cART. The 2-year overall and progression-free survival rates were both 75% (95% confidence interval: 64%, 88%). Factors associated with progression or death in univariate analysis were poor performance status [hazard ratio: 3.3 (1.2, 8.9)], more than one extranodal site [hazard ratio: 3.4 (1.1, 10.5)] and an advanced aaIPI [hazard ratio: 3.7 (1.0, 13.1)]. Progression-free survival after R-CHOP therapy did not differ from that of the HIV-negative counterparts (P = 0.11).

CONCLUSION

In the recent cART era, despite frequent high-risk features, the 2-year overall survival of HIV-DLBCL patients reaches 75%. Outcomes after R-CHOP therapy are similar to those of HIV-negative patients with similar aaIPI.

摘要

目的

非霍奇金淋巴瘤（NHL）仍然是艾滋病毒感染者（PLWHIV）中最常见的恶性肿瘤之一。近年来，HIV 相关弥漫性大 B 细胞淋巴瘤（DLBCL）患者的生存率显著提高，DLBCL 是最常见的 NHL 亚型之一。我们旨在分析现代联合抗逆转录病毒疗法（cART）时代感染 HIV 的患者中 DLBCL 的特征和结局。

设计

2008 年至 2015 年，前瞻性纳入法国 ANRS-CO16 Lymphovir 队列中的 PLWHIV 淋巴瘤患者。我们将接受 R-CHOP（利妥昔单抗、环磷酰胺、柔红霉素、长春新碱、泼尼松）治疗的患者与同时在淋巴瘤研究协会试验的 R-CHOP 臂中纳入的 HIV 阴性 DLBCL 患者进行比较。

结果

在 110 例 NHL 的 PLWHIV 中，52 例（47%）患有系统性 DLBCL。这些 52 例患者有频繁的结外疾病（81%）、不良的体能状态（35%）和高年龄调整国际预后指数（aaIPI）（58%），主要接受 R-CHOP 治疗（n=44，85%）。他们的中位 CD4 T 细胞计数为 233 个/μl，79%的患者接受 cART。2 年总生存率和无进展生存率均为 75%（95%置信区间：64%，88%）。单因素分析中与进展或死亡相关的因素包括不良的体能状态[风险比：3.3（1.2，8.9）]、超过一个结外部位[风险比：3.4（1.1，10.5）]和高 aaIPI[风险比：3.7（1.0，13.1）]。R-CHOP 治疗后的无进展生存率与 HIV 阴性患者无差异（P=0.11）。