中国HIV感染与未感染患者弥漫性大B细胞淋巴瘤的临床特征、表型标志物及预后
Clinical Features, Phenotypic Markers and Outcomes of Diffuse Large B-Cell Lymphoma between HIV-Infected and HIV-Uninfected Chinese Patients.
作者信息
Zhou Minghan, Cheng Jinlin, Zhao Handan, Yang Min, Yu Wenjuan, Qin Jiaying, Lang Guanjing, Tao Ran, Cao Qing, Huang Ying, Zhu Biao, Xu Lijun
机构信息
Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
出版信息
Cancers (Basel). 2022 Oct 31;14(21):5380. doi: 10.3390/cancers14215380.
Background: The effect of HIV infection on the clinicopathological characteristics of diffuse large B-cell lymphoma (DLBCL) remains debatable. Methods: Fifty-three HIV-infected and ninety-three HIV-uninfected DLBCL patients were enrolled in the retrospective study by propensity score matching for sex, age, body mass index and international prognostic index (IPI) at a ratio of 1:2. The clinicopathological characteristics were compared between the two groups. Results: HIV-infected DLBCL patients had lower white blood cell counts [×109/L; 4.4 (3.4−5.6) vs. 6.1 (4.2−8.2), p < 0.001], platelet counts (×109/L; 184.7 ± 89.3 vs. 230.0 ± 113.9, p = 0.014) and serum albumin (g/L; 37.3 ± 6.9 vs. 41.3 ± 6.2, p < 0.001) but higher incidences of central nervous system (CNS) involvement (9.4% vs. 1.1%, p = 0.014), bone marrow involvement (24.5% vs. 11.5%, p = 0.044) and Epstein−Barr viremia (61.1% vs. 26.7%, p = 0.002) than HIV-uninfected patients. In terms of histopathology, HIV-infected patients had higher positivity of Epstein−Barr virus-encoded small RNA (EBER) (41.7% vs. 6.7%, p = 0.002), but lower CD20 (90.2% vs. 98.7%, p= 0.029) and CD79a (23.1% vs. 53.7%, p < 0.001) expression. The overall response rate (ORR) at the end of chemotherapy (70.2% vs. 87.8%, p= 0.012) and 1-year overall survival (OS) (61.7% vs. 84.2%, log-rank p = 0.006) in HIV-infected patients were significantly lower than those in HIV-uninfected patients. Multivariate analysis suggested IPI ≤2.0 [adjusted odds ratio (AOR) (95% confidence interval): 5.0 (1.2−21.2), p = 0.030] was associated with ORR, hypoalbuminemia [AOR: 3.3 (1.3−9.1), p = 0.018] and CNS involvement [AOR: 3.3 (1.0−10.5), p = 0.044] were associated with reduced 1-year OS in HIV-infected patients. Conclusion: HIV-infected DLBCL patients have unique blood profiles and phenotypic markers. Low ORR and 1-year OS were observed in HIV-infected DLBCL patients in our study, even in the HAART era.
背景
HIV感染对弥漫性大B细胞淋巴瘤（DLBCL）临床病理特征的影响仍存在争议。方法：通过倾向评分匹配性别、年龄、体重指数和国际预后指数（IPI），以1:2的比例纳入53例HIV感染的DLBCL患者和93例未感染HIV的DLBCL患者进行回顾性研究。比较两组的临床病理特征。结果：HIV感染的DLBCL患者白细胞计数[×10⁹/L；4.4（3.4 - 5.6）对6.1（4.2 - 8.2），p < 0.001]、血小板计数（×10⁹/L；184.7 ± 89.3对230.0 ± 113.9，p = 0.014）和血清白蛋白（g/L；37.3 ± 6.9对41.3 ± 6.2，p < 0.001）较低，但中枢神经系统（CNS）受累（9.4%对1.1%，p = 0.014）、骨髓受累（24.5%对11.5%，p = 0.044）和EB病毒血症（61.1%对26.7%，p = 0.002）的发生率高于未感染HIV的患者。在组织病理学方面，HIV感染患者的EB病毒编码小RNA（EBER）阳性率较高（41.7%对6.7%，p = 0.002），但CD20（90.2%对98.7%，p = 0.029）和CD79a（23.1%对53.7%，p < 0.001）表达较低。HIV感染患者化疗结束时的总缓解率（ORR）（70.2%对87.8%，p = 0.012）和1年总生存率（OS）（61.7%对84.2%，对数秩检验p = 0.006）显著低于未感染HIV的患者。多因素分析表明，IPI≤2.0[调整优势比（AOR）（95%置信区间）：5.0（1.2 - 21.2），p = 0.030]与ORR相关，低白蛋白血症[AOR：3.3（1.3 - 9.1），p = 0.018]和CNS受累[AOR：3.3（1.0 - 10.5），p = 0.044]与HIV感染患者1年OS降低相关。结论：HIV感染的DLBCL患者具有独特的血液学特征和表型标志物。在我们的研究中，即使在高效抗逆转录病毒治疗（HAART）时代，HIV感染的DLBCL患者的ORR和1年OS也较低。
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