Division of Infectious Diseases, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Division of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Apr;83(4):371-376. doi: 10.1097/JCMA.0000000000000279.
Despite the effectiveness of combination antiretroviral therapy, persons living with human immunodeficiency virus (PLWHIV) remain at a high risk of developing non-Hodgkin lymphoma (NHL). We aimed to analyze the demographics and outcomes of the HIV-associated NHLs.
Between 2005 and 2014, PLWHIV with NHLs were retrospectively enrolled at a tertiary referral center. Characteristics and survival were reviewed and analyzed.
Twenty-two HIV-associated NHLs were identified, with a median follow-up of 14 months (range, 0.1-139.7), including eight diffuse large B-cell lymphomas (DLBCLs), eight primary central nervous system lymphomas (PCNSLs), and six Burkitt's lymphomas (BLs). Nine patients (40.9%) were diagnosed with NHLs and HIV infection concurrently. The prognosis of DLBCL patients tended to be better prognosis than that of BL and PCNSL patients (median overall survival: not reached vs. 3.5 months, p = 0.056). Very early mortality (death within 14 days after NHL diagnosis) was noted in five patients (22.7%), and tumor lysis syndrome (TLS) is a predictive factor for very early mortality among PLWHIV (hazard ratio:11.3, 95% confidence interval: 1.1-114.4, p = 0.04).
Management of the early treatment phase of HIV-associated NHLs remains a major challenge. Careful intervention to patients with TLS might be the key to improve treatment outcomes.
尽管联合抗逆转录病毒疗法有效，但人类免疫缺陷病毒（HIV）感染者仍存在发生非霍奇金淋巴瘤（NHL）的高风险。我们旨在分析 HIV 相关 NHL 的人口统计学特征和结局。
在 2005 年至 2014 年期间，我们回顾性地在一家三级转诊中心招募了患有 NHL 的 HIV 感染者。对患者的特征和生存情况进行了回顾和分析。
共确定了 22 例 HIV 相关 NHL，中位随访时间为 14 个月（范围 0.1-139.7），包括 8 例弥漫性大 B 细胞淋巴瘤（DLBCL）、8 例原发性中枢神经系统淋巴瘤（PCNSL）和 6 例伯基特淋巴瘤（BL）。9 例（40.9%）患者同时诊断为 NHL 和 HIV 感染。DLBCL 患者的预后倾向于好于 BL 和 PCNSL 患者（中位总生存期：未达到 vs. 3.5 个月，p=0.056）。5 例患者（22.7%）出现极早期死亡（NHL 诊断后 14 天内死亡），肿瘤溶解综合征（TLS）是 HIV 感染者极早期死亡的预测因素（风险比：11.3，95%置信区间：1.1-114.4，p=0.04）。
HIV 相关 NHL 早期治疗阶段的管理仍然是一个主要挑战。对 TLS 患者进行仔细干预可能是改善治疗结局的关键。
