人类免疫缺陷病毒相关非霍奇金淋巴瘤治疗中的预后因素：艾滋病临床试验组方案142分析——低剂量与标准剂量m-BACOD加粒细胞巨噬细胞集落刺激因子。美国国立过敏与传染病研究所。

Prognostic factors in the treatment of human immunodeficiency virus-associated non-Hodgkin's lymphoma: analysis of AIDS Clinical Trials Group protocol 142--low-dose versus standard-dose m-BACOD plus granulocyte-macrophage colony-stimulating factor. National Institute of Allergy and Infectious Diseases.

作者信息

Straus D J, Huang J, Testa M A, Levine A M, Kaplan L D

机构信息

Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

出版信息

J Clin Oncol. 1998 Nov;16(11):3601-6. doi: 10.1200/JCO.1998.16.11.3601.

DOI:10.1200/JCO.1998.16.11.3601

PMID:9817281

Abstract

PURPOSE

The overall results of chemotherapy in human immunodeficiency virus (HIV)-associated non-Hodgkin's lymphoma (NHL) have been poor. To define a subgroup of patients who may have a better outcome, an analysis of prognostic factors was performed of patients treated in AIDS Clinical Trials Group (ACTG) protocol 142, a phase III randomized trial of low-dose versus standard-dose methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) plus granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment of patients with newly diagnosed HIV-associated NHL.

MATERIALS AND METHODS

The following baseline variables were included as potential predictors of survival among 192 patients who received treatment: age; intravenous drug use (IVDU); specific type of sexual contact as risk factors (homosexual, bisexual, or heterosexual contact); prior AIDS diagnosis; CD4 cell count; serum lactic acid dehydrogenase (LDH); histology; Karnofsky performance status (KPS); stage; B symptoms; race (white/nonwhite); nodal involvement; extranodal involvement; number of extranodal sites; specific sites: bone marrow, liver, kidney, lung, or gastrointestinal tract; and treatment arm (standard-dose m-BACOD/low-dose m-BACOD).

RESULTS

Age greater than 35 years, IVDU, stages III/IV, and CD4 cell counts less than 100/microL were adverse prognostic factors in multivariate analyses using the Cox proportional hazards model. The median overall survival for patients with none or one of the adverse factors was 46 weeks, with two was 44 weeks, and with three or four was 18 weeks. At 144 weeks, 29.5% of patients with none or one, 16.9% with two, and 0% with three or four factors were alive (P < .001).

CONCLUSION

Long-term survival can be achieved in approximately one third of patients with HIV-associated NHL with favorable characteristics.

摘要

目的

人类免疫缺陷病毒（HIV）相关非霍奇金淋巴瘤（NHL）的化疗总体效果不佳。为了确定可能有更好预后的患者亚组，对参与艾滋病临床试验组（ACTG）142方案治疗的患者进行了预后因素分析，该方案是一项比较低剂量与标准剂量甲氨蝶呤、博来霉素、阿霉素、环磷酰胺、长春新碱和地塞米松（m - BACOD）加粒细胞 - 巨噬细胞集落刺激因子（GM - CSF）治疗新诊断的HIV相关NHL患者的III期随机试验。

材料与方法

将以下基线变量作为192例接受治疗患者生存的潜在预测因素：年龄；静脉吸毒（IVDU）；作为危险因素（同性恋、双性恋或异性恋接触）的特定性接触类型；既往艾滋病诊断；CD4细胞计数；血清乳酸脱氢酶（LDH）；组织学；卡诺夫斯基体能状态（KPS）；分期；B症状；种族（白人/非白人）；淋巴结受累；结外受累；结外部位数量；特定部位：骨髓、肝脏、肾脏、肺或胃肠道；以及治疗组（标准剂量m - BACOD/低剂量m - BACOD）。

结果

使用Cox比例风险模型进行多因素分析时，年龄大于35岁、IVDU、III/IV期以及CD4细胞计数低于100/μL是不良预后因素。无不良因素或仅有一个不良因素的患者中位总生存期为46周，有两个不良因素的患者为44周，有三个或四个不良因素的患者为18周。在144周时，无不良因素或仅有一个不良因素的患者中有29.5%存活，有两个不良因素的患者中有16.9%存活，有三个或四个不良因素的患者中无一人存活（P <.001）。