Chen J, Mehraj V, Szabo J, Routy B, Michel R P, Routy J P
Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC.
Research Institute of the McGill University Health Centre, Montreal, QC.
Curr Oncol. 2018 Dec;25(6):e592-e596. doi: 10.3747/co.25.4119. Epub 2018 Dec 1.
Primary effusion lymphoma (pel) is a rare human herpesvirus 8 (hhv8)-related large B cell lymphoma with plasmablastic, immunoblastic, or anaplastic features that often carries a poor prognosis. This lymphoma occurs mainly in patients with hiv infection, most often with Epstein-Barr virus (ebv) co-infection, and usually presents as body cavity effusions or, less commonly, as extracavitary lesions without effusion (ec-pel). Chemotherapeutic treatment options are limited and require concurrent antiretroviral therapy (art). Here, we report the case of an adult patient with hiv infection and chronic hepatitis E virus (hev) co-infection who had low CD4 T cell recovery after years of art. The patient then developed a cutaneous ec-pel which rapidly regressed after 1 cycle of liposomal doxorubicin (ld) for his Kaposi sarcoma (ks) before treatment with chop chemotherapy. He had previously received numerous cycles of ld for cutaneous ks over 2 years. Because of the patient's low CD4 T cell count, hev co-infection, and earlier unexpected remission of ec-pel before chop, the patient opted for a single trial of ld before other options. Surprisingly, he experienced a complete remission lasting 18 months. Subsequently, his ec-pel relapsed twice at 31 and at 41 months after the initial diagnosis. Upon recurrence, a similar single cycle of ld was given, which again induced remission. The patient today is in complete remission after a total of 4 ld infusions over 54 months. This patient represents a unique case of hiv-with-hhv8-related, ebv-negative ec-pel with chronic hev coinfection, in which rapid remission was achieved after a single cycle of ld, suggesting an antiviral response in addition to the chemotherapeutic effect.
原发性渗出性淋巴瘤（PEL）是一种罕见的与人类疱疹病毒8型（HHV8）相关的大B细胞淋巴瘤，具有浆母细胞、免疫母细胞或间变性特征，预后通常较差。这种淋巴瘤主要发生在HIV感染患者中，最常见的是与爱泼斯坦-巴尔病毒（EBV）合并感染，通常表现为体腔积液，或较少见地表现为无积液的腔外病变（EC-PEL）。化疗治疗选择有限，需要同时进行抗逆转录病毒治疗（ART）。在此，我们报告一例成年患者，该患者感染HIV并合并慢性戊型肝炎病毒（HEV），在接受多年ART治疗后CD4 T细胞恢复不佳。该患者随后发生了皮肤EC-PEL，在接受CHOP化疗前，因患有卡波西肉瘤（KS）接受了1个周期的脂质体阿霉素（LD）治疗后，皮肤EC-PEL迅速消退。他此前在2年多的时间里因皮肤KS接受了多次LD治疗。由于患者CD4 T细胞计数低、合并HEV感染以及在接受CHOP治疗前EC-PEL出现意外缓解，患者在选择其他治疗方案之前先进行了单次LD试验。令人惊讶的是，他实现了持续18个月的完全缓解。随后，在初次诊断后的31个月和41个月，他的EC-PEL复发了两次。复发时，给予了类似的单次LD治疗周期，再次诱导缓解。在54个月内共接受了4次LD输注后，该患者如今处于完全缓解状态。该患者代表了一例独特的HIV合并HHV8相关、EBV阴性的EC-PEL合并慢性HEV感染病例，其中单次LD治疗周期后迅速缓解，提示除化疗作用外还存在抗病毒反应。
