初治后缓解的恶性淋巴瘤并 HIV 感染患者具有极好的预后。

Patients With Malignant Lymphoma and HIV Infection Experiencing Remission After First-Line Treatment Have an Excellent Prognosis.

机构信息

Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany.

出版信息

Clin Lymphoma Myeloma Leuk. 2019 Oct;19(10):e581-e587. doi: 10.1016/j.clml.2019.05.019. Epub 2019 May 30.

DOI:10.1016/j.clml.2019.05.019

PMID:31377211

Abstract

BACKGROUND

Malignant lymphoma is still the leading cause of death among AIDS-related diseases.

PATIENTS AND METHODS

We performed a retrospective analysis of 50 HIV-positive lymphoma patients. The median interval between HIV and malignant lymphoma diagnosis was 4 years. Eight patients (16%) had Hodgkin lymphoma and 42 (84%) non-Hodgkin lymphoma. Among non-Hodgkin lymphoma patients, diffuse large B-cell lymphoma (n = 18, 42%), Burkitt lymphoma (n = 11, 26%), and plasmoblastic lymphoma (n = 5, 12%) were the most frequent entities.

RESULTS

Lymphoma was treated according to standard protocols. Forty-four patients (88%) received combination antiretroviral therapy, 2 (4%) were not treated, and in 4 (8%) the HIV treatment status was not clarified. Response to first-line therapy was complete response (CR) in 24 (56%), partial response (PR) in 15 (35%), and stable disease in 1 (2%). Three patients (7%) developed progressive disease, and 9 (18%) experienced relapse after CR or PR. At a median observation period of 31 (range, 0.4-192) months, the 1-, 2-, and 5-year overall survival was 87%, 79%, and 76%, respectively. At univariate analysis, remission status after first-line treatment was predictive of outcome, as the 2-year overall survival was 95%, 66%, and 0 for patients with CR, with PR, and with progressive disease (P < .001). Results of the multivariate analysis revealed lactate dehydrogenase concentration at lymphoma diagnosis (P = .046) and relapse (P = .050) to be independent factors for overall survival.

CONCLUSION

First-line treatment of lymphoma in HIV positive patients is crucial. Patients who experienced and maintained a first CR had a favorable prognosis.

摘要

背景

恶性淋巴瘤仍然是艾滋病相关疾病死亡的主要原因。

患者和方法

我们对 50 例 HIV 阳性淋巴瘤患者进行了回顾性分析。HIV 和恶性淋巴瘤诊断之间的中位间隔为 4 年。8 例（16%）为霍奇金淋巴瘤，42 例（84%）为非霍奇金淋巴瘤。在非霍奇金淋巴瘤患者中，弥漫性大 B 细胞淋巴瘤（n=18，42%）、伯基特淋巴瘤（n=11，26%）和浆母细胞淋巴瘤（n=5，12%）最为常见。

结果

淋巴瘤根据标准方案进行治疗。44 例（88%）患者接受了联合抗逆转录病毒治疗，2 例（4%）未接受治疗，4 例（8%）患者的 HIV 治疗情况不详。一线治疗的反应为完全缓解（CR）24 例（56%），部分缓解（PR）15 例（35%），稳定 1 例（2%）。3 例（7%）患者出现疾病进展，9 例（18%）CR 或 PR 后复发。在中位观察期 31 个月（范围 0.4-192 个月）时，1、2 和 5 年总生存率分别为 87%、79%和 76%。单因素分析显示，一线治疗后的缓解状态是影响预后的因素，CR、PR 和疾病进展患者的 2 年总生存率分别为 95%、66%和 0（P<0.001）。多因素分析结果显示，淋巴瘤诊断时乳酸脱氢酶浓度（P=0.046）和复发（P=0.050）是总生存的独立因素。