57例人类免疫缺陷病毒感染合并Burkkit淋巴瘤患者的临床分析

Clinical analysis on 57 patients with human immunodeficiency virus infection and Burkkit lymphoma

目的探讨人类免疫缺陷病毒(HIV)感染合并Burkkit淋巴瘤患者的临床特征、治疗和预后。方法收集2010年12月至2021年6月首都医科大学附属北京地坛医院收治的HIV感染合并Burkkit淋巴瘤患者为研究对象,分析其临床特征、治疗方案和疗效等,随访患者预后,并应用Cox多因素分析法分析预后影响因素。结果共收集179例HIV合并淋巴瘤患者临床资料,其中57例为Burkkit淋巴瘤患者(31.8%),由组织学确诊和细胞学确诊分别为46例和11例,其中3例为原发中枢Burkkit淋巴瘤,54例确诊为非中枢Burkkit淋巴瘤。在54例非中枢Burkkit淋巴瘤中,初诊Ann Arbor分期Ⅲ/Ⅳ期患者41例。57例患者中位年龄为43岁(21~60岁),发病时CD4+T细胞<200个/μl患者占47.4%(27例)。5例患者因肝肾功能衰竭或合并严重感染无法治疗,4例失访,余45例非原发中枢的Burkkit淋巴瘤患者接受全身化疗加减利妥昔单抗。45例患者主要采用CODOX-M(环磷酰胺、长春新碱、阿霉素、地塞米松联合甲氨蝶呤)/IVAC±R(异环磷酰胺、阿糖胞苷、依托泊苷±利妥昔单抗)或EPOCH-R(依托泊苷、泼尼松、长春新碱、环磷酰胺、阿霉素联合利妥昔单抗)治疗,疾病完全缓解率为37.8%(17例),中位总生存期为16.0个月(95%CI:12.4~19.6)。原发结外器官为独立的预后不良因素(HR=10.18、95%CI:2.48~41.73、P=0.001)。结论HIV感染合并Burkkit淋巴瘤患者确诊时多数处于疾病晚期,部分患者已经丧失治疗机会,且预后差,尚需探讨更有效、低毒的治疗方案。

Objective To investigate the clinical characteristics,treatment and prognosis of patients with human immunodeficiency virus(HIV)infection and Burkkit lymphoma.Methods The clinical data of HIV-positive patients with Burkkit lymphoma from December 2010 to June 2021 in Beijing Ditan hospital,Capital Medical University were collected.The disease features,treatment regimens and prognosis were analyzed.And the prognostic factors were evaluated by multivariable Cox proportional hazards model.Results Total of 179 HIV-positive patients with Burkkit lymphoma were enrolled consecutively.The frequency of Burkkit lymphoma was 31.8%(57/179),of whom 46 cases were diagnosed by histology and 11 cases were diagnosed by cytology.Three patients were primary central nervous Burkkit lymphoma,the others were diagnosed as non-primary central nervous Burkkit lymphoma,of whom 41 patients were diagnosed with Ann Arbor stageⅢ/Ⅳ.Median age was 43 years(21-60 years old).There were 27 cases(47.4%)with baseline median absolute CD4+T<200 cells/μl.Five patients could not be treated due to liver and kidney failure or severe infection,and 4 patients were lost to follow-up.And the rest 45 patients with non-primary central nervous Burkkit lymphoma received systemic chemotherapy with or without rituximab.The 45 patients received CODOX-M(cyclophosphamide,vincristine,doxorubixin,dexamethasone-MTX)/IVAC±R(ifosfamide,cytarabine,etoposide±rituximab)or EPOCH-R(etoposide,prednison,vincristine,cyclophosphamide,doxorubixin-rituximab)treatment.The complete response rate was 37.8%(17/45).The median overall survival was 16.0 months(95%CI:12.4-19.6).The primary extral nodal organ disease was defined as an adverse prognostic factor(HR=10.18,95%CI:2.48-41.73,P=0.001).Conlusions Most patients with HIV infection combined with Burkkit lymphoma are in the advanced stage of the disease when diagnosed,which partially lose the opportunity of treatment,and the prognosis is poor.More effective and low-toxicity treatment options need to be explored.