摘要
目的分析比较人类免疫缺陷病毒(HIV)阳性与阴性弥漫大B细胞淋巴瘤患者的临床特点及疗效。方法收集博茨瓦纳弗朗西斯敦市仰加奎医院肿瘤内科2012年3月至2015年3月诊治的弥漫大B细胞淋巴瘤患者共71例,其中HIV阳性37例,HIV阴性34例,给予CHOP方案一线化疗,对两组的临床特点及疗效进行分析。结果与HIV阴性组相比,HIV阳性组B症状发生率高(56.8%vs.29.4%;P=0.020),更容易出现胃肠道(37.8%vs.14.7%;P=0.028)、肝(29.7%vs.9.7%;P=0.027)、肺(27.0%vs.9.7%;P=0.048)浸润。HIV阳性组与HIV阴性组治疗完全缓解率分别为18.9%(7/37)与41.2%(14/34)(P=0.040);客观有效率分别为48.6%(18/37)与70.6%(24/34)(P=0.060)。HIV阳性组化疗后出现贫血、白细胞下降及继发感染比例高于HIV阴性组(均P<0.05)。HIV阳性组中有24例在确诊淋巴瘤前已给予高效价抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)治疗,13例确诊后给予HARRT治疗,其客观有效率分别为41.7%和61.5%(P=0.248)。CD4+细胞数>200/mm3和≤200/mm3患者,其客观有效率分别为71.4%和34.8%(P=0.031)。结论 HIV阳性患者就诊时表现出更强的侵袭性。结合HARRT治疗,CHOP方案可使HIV阳性患者达到类似于HIV阴性患者的客观有效率,但完全缓解率低。HIV阳性组患者HARRT起始治疗时间不影响近期疗效。CD4^+细胞数低是近期疗效不良的预测因素。
Objective To compare the clinical features and short-term efficacy between diffuse large B-cell lymphomas（DLBCL） of HIV-infected and non-HIV-infected patients. Methods We collected the data of 71 patients with DLBCL in Botswana from March 2012 to March 2015. Clinical manifestation, therapy and efficacy of CHOP in the first-line treatment were compared between patients with（n=37） and without（n=34） HIV. Results There were differences between HIV-infected and non-HIV-infected patients regarding the following features： B-symptoms incidence（56.8% vs. 29.4%; P=0.020）, extranodal involvement： gastrointestinal（37.8% vs. 14.7%; P=0.028）, Liver（29.7% vs. 9.7%; P=0.027）, Lung（27.0% vs. 9.7%; P=0.048）. The complete response（CR） rate was better in non-HIV-infected than that in HIV-infected patients（41.2% vs. 18.9%; P=0.040） and there was a trend for more non-HIV-infected patients to have high objective response rate（ORR） than HIV-infected patients（70.6% vs. 48.6%; P=0.060）. More HIV-infected patients had anemia, leukocytopenia, infection（P0.05）. HIV-infected patients were classified according to the time of highly active antiretroviral therapy（HARRT） onset, on HARRT（n=24） and not on HARRT（n=13） at DLBCL diagnosis; Time of HARRT onset had no effect on ORR（41.7% vs. 61.5%; P=0.248）. The ORR was better in CD4＋200/mm3 patients than that in CD4＋≤200/mm3 patients（71.4% vs. 34.8%; P=0.031）. Conclusion HIV-infected DLBCL patients have more aggressive features and they can achieve similar ORR as their HIV-negative counterparts when they receive CHOP regimen. But the CR rate is worse in HIVinfected than that in non-HIV-infected patients. In HIV-infected patients, the time of HARRT onset has no effect on the short term efficacy. Low CD4＋ count is the adverse predictor of short term efficacy.
出处
《肿瘤防治研究》
CAS
CSCD
北大核心
2016年第5期387-391,共5页
Cancer Research on Prevention and Treatment
