根据抗逆转录病毒治疗的选择，HIV感染的淋巴瘤患者的生存情况：一项多中心观察性研究。
Survival in HIV-infected patients with lymphoma according to the choice of antiretroviral treatment: an observational multicentre study.
作者信息
Focà E, Cavaglià G, Rusconi S, Cascavilla A, Cenderello G, Re A, Casari S, van den Bogaart L, Zinzani P L, Caracciolo D, Di Perri G, Bonito A, Lucchini A, Cassola G, Viale P, Calcagno A
机构信息
Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili Hospital, Brescia, Italy.
Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy.
出版信息
HIV Med. 2018 Jun 4. doi: 10.1111/hiv.12624.
OBJECTIVES
Lymphoproliferative disorders are often observed in HIV-positive patients. Combination antiretroviral treatment (cART) during antineoplastic chemotherapy is beneficial, but little is known about the clinical outcome according to different antiretroviral combinations. The aim of the study was to address this gap in current knowledge.
METHODS
A retrospective study was conducted in five large Italian centres for the period from 1998 to 2015; HIV-positive patients diagnosed with lymphoma were included and demographic, clinical and therapeutic variables were recorded and associated with clinical outcomes. Bivariate and multivariate analyses were performed, including Cox proportional hazard models for survival.
RESULTS
A total of 399 patients were included in the study. The most common types of lymphoma were diffuse large B-cell lymphoma (DLCLB; n = 164), Hodgkin lymphoma (HL; n = 99) and Burkitt lymphoma (BL; n = 57), followed by plasmablastic lymphoma (PBL; n = 38), T-cell lymphoma (TCL; n = 17), indolent lymphoma (n = 10) and other less common types (n = 14). cART was given to 327 (out of 387 evaluable) patients: in 216 subjects it was protease inhibitor (PI)-based, in 73 it was nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and in 18 it was integrase strand transfer inhibitor (INSTI)-based (the remaining 20 individuals received other regimens). The 5-year overall survival was 57.5% (52.8% for DLCLB, 67.8% for HL, 42.3% for BL, 60.6% for PBL and 64.7% for TCL). PI-based ART compared with other compounds was associated with worse survival in non-Hodgkin lymphoma (NHL) and HL patients combined (P ≤ 0.001) and in NHL patients alone (P < 0.001); grade 3-4 haematological toxicities were more commonly observed in PI-treated individuals. Lymphoma diagnosis in recent years, better immunovirological status, lower lymphoma stage and better prognostic indexes were associated with better survival.
CONCLUSIONS
PI-based cART while on chemotherapy was associated with worse overall survival and more frequent haematological complications in HIV-positive patients with lymphoma.
目的
在HIV阳性患者中常观察到淋巴增殖性疾病。抗肿瘤化疗期间联合抗逆转录病毒治疗（cART）是有益的，但对于不同抗逆转录病毒联合方案的临床结局知之甚少。本研究的目的是填补当前知识的这一空白。
方法
在意大利五个大型中心进行了一项回顾性研究，研究时间为1998年至2015年；纳入诊断为淋巴瘤的HIV阳性患者，并记录人口统计学、临床和治疗变量，并将其与临床结局相关联。进行了双变量和多变量分析，包括生存的Cox比例风险模型。
结果
共399例患者纳入研究。最常见的淋巴瘤类型为弥漫性大B细胞淋巴瘤（DLCLB；n = 164）、霍奇金淋巴瘤（HL；n = 99）和伯基特淋巴瘤（BL；n = 57），其次是浆母细胞淋巴瘤（PBL；n = 38）、T细胞淋巴瘤（TCL；n = 17）、惰性淋巴瘤（n = 10）和其他较罕见类型（n = 14）。387例可评估患者中有327例接受了cART：216例患者接受基于蛋白酶抑制剂（PI）的治疗，73例接受基于非核苷类逆转录酶抑制剂（NNRTI）的治疗，18例接受基于整合酶链转移抑制剂（INSTI）的治疗（其余20例接受其他方案）。5年总生存率为57.5%（DLCLB为52.8%，HL为67.8%，BL为42.3%，PBL为60.6%，TCL为64.7%）。与其他化合物相比，基于PI的抗逆转录病毒治疗与非霍奇金淋巴瘤（NHL）和HL患者联合（P≤0.001）以及单独NHL患者（P<0.001）的较差生存率相关；3-4级血液学毒性在接受PI治疗的个体中更常见。近年来的淋巴瘤诊断、更好的免疫病毒学状态、更低的淋巴瘤分期和更好的预后指标与更好的生存率相关。
结论
化疗期间基于PI的cART与淋巴瘤HIV阳性患者较差的总生存率和更频繁的血液学并发症相关。
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