人类免疫缺陷病毒阳性和阴性弥漫大B细胞淋巴瘤的临床特点及近期疗效分析

朱晋峰; KumarSaurabha; NancyKablay; 庞红霞

doi:10.3971/j.issn.1000-8578.2016.05.014

人类免疫缺陷病毒阳性和阴性弥漫大B细胞淋巴瘤的临床特点及近期疗效分析

Differences of Clinical Features and Short-term Efficacy Between Diffuse Large B-cell Lymphomas of HIV-infected and Non-HIV-infected Patients

摘要

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。

Abstract:
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 (P<0.05). 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 HIV-infected 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.

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