Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa.
Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa.
PLoS One. 2022 Sep 1;17(9):e0272282. doi: 10.1371/journal.pone.0272282. eCollection 2022.
To describe 4-year survival outcomes and assess the value of established and additional relevant variables to predict complete response (CR), four-year progression-free survival (PFS) and overall survival (OS) of CD20 positive AIDS-Related Lymphoma (ARL) treated with standard combination chemotherapy.
We performed a retrospective review of patients diagnosed with CD20 positive ARL between 2006 and 2016. All patients over 12 years of age who received at least one cycle of combination chemotherapy with curative intent were included in the analysis. Variables assessed included the International Prognostic Index (IPI), age-adjusted-IPI, age, gender, B symptoms, extent of disease, functional performance status, CD4 cell count, viral load, concurrent ART with chemotherapy, rituximab inclusion, and number of chemotherapy cycles used. Kaplan-Meier survival curves for OS and PFS at 4 years were compared for IPI and aaIPI using the log-rank test. A Cox proportional hazards model was used to investigate the effects of prognostic variables for patients achieving OS and PFS at 4 years and logistic regression for patients achieving CR.
A total of 102 patients were included in the analysis. At year four of follow-up, the OS was 50% (n = 51) and PFS was 43% (n = 44). Attaining a CR and male gender were significantly associated with improved 4-year OS (p<0.001 and p = 0.028 respectively) and PFS (p<0.001 and 0.048 respectively). A viral load of < 50 copies/ml was associated with a higher complete response rate (aOR 6.10 [95% CI 1.15, 24.04], p = 0.01). Six or more cycles of chemotherapy was superior to fewer cycles for both PFS (aHR 0.17 [95% CI 0.10, 0.29]) and OS (aHR 0.12 [95% CI 0.07, 0.22]) with p-value < 0.001 for both PFS and OS. The Kaplan-Meier survival estimates demonstrated the prognostic utility of the IPI and aaIP for OS (p = 0.002 and 0.030 respectively) and the IPI for PFS (p = 0.002).
This study is a first from a high prevalence HIV area in KwaZulu-Natal, South Africa, and confirms the utility of the internationally accepted prognostic scoring systems in predicting survival in CD20 positive ARL in the local population.
描述 4 年生存率结果，并评估既定和其他相关变量的价值，以预测接受标准联合化疗治疗的 CD20 阳性艾滋病相关淋巴瘤（ARL）患者的完全缓解（CR）、4 年无进展生存期（PFS）和总生存期（OS）。
我们对 2006 年至 2016 年间诊断为 CD20 阳性 ARL 的患者进行了回顾性研究。所有年龄在 12 岁以上、接受至少一个周期治愈性联合化疗的患者均纳入分析。评估的变量包括国际预后指数（IPI）、年龄调整的 IPI、年龄、性别、B 症状、疾病范围、功能状态、CD4 细胞计数、病毒载量、化疗期间同时进行的抗逆转录病毒治疗（ART）、利妥昔单抗的应用以及使用的化疗周期数。使用对数秩检验比较 IPI 和 aaIPI 的 OS 和 PFS 4 年 Kaplan-Meier 生存曲线。使用 Cox 比例风险模型调查对患者 4 年 OS 和 PFS 有影响的预后变量，并使用逻辑回归对患者达到 CR 的情况进行分析。
共有 102 例患者纳入分析。在随访 4 年时，OS 为 50%（n=51），PFS 为 43%（n=44）。达到 CR 和男性是与 4 年 OS（p<0.001 和 p=0.028）和 PFS（p<0.001 和 0.048）显著相关的因素。病毒载量<50 拷贝/ml 与更高的完全缓解率相关（aOR 6.10[95%CI 1.15, 24.04]，p=0.01）。与较少周期相比，6 个或更多周期的化疗在 PFS（aHR 0.17[95%CI 0.10, 0.29]）和 OS（aHR 0.12[95%CI 0.07, 0.22]）方面均有优势，且在 PFS 和 OS 方面的 p 值均<0.001。Kaplan-Meier 生存估计表明，IPI 和 aaIP 对 OS（p=0.002 和 0.030）和 IPI 对 PFS（p=0.002）有预后作用。
这是南非夸祖鲁-纳塔尔省高艾滋病流行地区的第一项研究，证实了国际公认的预后评分系统在预测当地人群 CD20 阳性 ARL 患者生存方面的效用。
