艾滋病相关弥漫性大B细胞淋巴瘤的临床特征及预后相关因素分析

Clinical features and prognostic factors of AIDS-associated diffuse large B-cell lymphoma

探讨艾滋病相关弥漫性大B细胞淋巴瘤(AIDS-DLBCL)患者的一般临床特征和治疗转归,为AIDS-DLBCL患者的诊疗、生存预后及预防管理提供参考。选取2017年1月至2020年1月长沙市第一医院接受联合抗逆转录病毒治疗的AIDS-DLBCL患者,通过生存分析Kaplan-Meier法绘制生存曲线、采用Cox比例风险回归模型分析AIDS-DLBCL特异性变量与无进展生存期和总生存期之间的关联。本研究共纳入50例AIDS-DLBCL患者,年龄M(Q1,Q3)为52(44,59)岁,46例(92%)为男性。20例(40%)患者接受以环磷酰胺、多柔比星、长春新碱、强的松(CHOP)治疗方案,23例(46%)患者接受以利妥昔单抗联合环磷酰胺、多柔比星、长春新碱、强的松(RCHOP)治疗方案。生存曲线分析显示,AIDS-DLBCL患者2年无进展生存率和总生存率分别为56.9%和61.6%,RCHOP方案合并EBV-DNA≥1000 copies/ml患者的无进展生存率(χ^(2)=3.844,P=0.043)以及总生存率(χ^(2)=4.662,P=0.031)高于CHOP方案合并EBV-DNA≥1000 copies/ml。多因素分析显示,男性(HR=2.70,95%CI:1.10~6.80)、EBV载量≥1000 copies/ml(HR=1.75,95%CI:1.12~2.84)、HIV-RNA≥200 copies/ml(HR=4.64,95%CI:1.73~12.15)、ECOG PS评分2~4分(HR=3.54,95%CI:1.62~7.33)、国际预后指数(IPI)评分3~5分(HR=5.21,95%CI:1.39~20.14)患者疾病发生进展的风险大。RCHOP方案合并EBV载量≥1000 copies/ml(HR=0.07,95%CI:0.05~0.93)患者疾病发生进展的风险小。男性(HR=2.87,95%CI:1.65~9.17)、EBV载量≥1000 copies/ml(HR=1.61,95%CI:4.02~9.36)、HIV-RNA≥200 copies/ml(HR=1.19,95%CI:1.58~2.74)、ECOG PS评分2~4分(HR=6.42,95%CI:2.55~14.33)、IPI评分3~5分(HR=2.78,95%CI:1.41~12.96)患者死亡风险高,RCHOP方案合并EBV载量≥1000 copies/ml(HR=0.24,95%CI:0.64~0.90)患者死亡风险低。综上,男性、ECOG体能状态评分2~4分、IPI评分3~5分、EBV载量≥1000 copies/ml、HIV病毒载量≥200 copies/ml是影响AIDS-DLBCL患者无进展生存期和总生存期的危险因素。RCHOP方案合并EBV载量≥1000 copies/ml是影响AIDS-DLBCL患者无进展生存期和总生存期的保护因素。

To explore the general clinical features and treatment outcomes of patients with AIDS-related diffuse large B-cell lymphoma(AIDS-DLBCL)and provide a theoretical basis for diagnosis and treatment,survival prognosis,prevention and management of AIDS-DLBCL patients.AIDS-DLBCL patients who received combined antiretroviral therapy(cART)at Changsha First Hospital from January 2017 to January 2020 were selected in this study.The survival curves were plotted using the Kaplan-Meier method,and the Cox proportional hazards regression model was used to analyze the association between AIDS-DLBCL specific variables and progression-free survival and overall survival.Correlation analysis was conducted based on the clinical features of the patients.A total of 50 AIDS-DLBCL patients were included.Their median age(Q 1,Q 3)was 52(44,59)years,of whom 46(92%)were male.About 20(40%)patients received treatment with cyclophosphamide,doxorubicin,vincristine,and prednisone(CHOP),while 23 patients(46%)received treatment with rituximab combined with cyclophosphamide,doxorubicin,vincristine,and prednisone(RCHOP).Survival curve analysis showed that the 2-year progression-free survival rate and overall survival rate of AIDS-DLBCL patients were 56.9%and 61.6%,respectively.Patients with RCHOP protocol combined with EBV-DNA≥1000 copies/ml had higher progression-free survival rate(χ^(2)=3.844,P=0.043)and overall survival rate(χ^(2)=4.662,P=0.031)than those with CHOP protocol combined with EBV-DNA≥1000 copies/ml.A multivariate analysis showed that male(HR=2.70,95%CI:1.10-6.80),EB viral load≥1000 copies/ml(HR=1.75,95%CI:1.12-2.84),HIV-RNA≥200 copies/ml(HR=4.64,95%CI:1.73-12.15),ECOG PS score of 2 to 4 points(HR=3.54,95%CI:1.62-7.33),and international prognostic index(IPI)score of 3 to 5 points(HR=5.21,95%CI:1.39-20.14)were at a higher risk of disease progression.Patients with EB viral load≥1000 copies/ml(HR=0.07,95%CI:0.05-0.93)on the RCHOP regimen had a small risk of disease progression.Males(HR=2.87,95%CI:1.65-9.17),EB viral load≥1000 copies/ml(HR=1.61,95%CI:4.02-9.36),HIV-RNA≥200 copies/ml(HR=1.19,95%CI:1.58-2.74),ECOG PS score of 2 to 4(HR=6.42,95%CI:2.55-14.33),IPI score of 3 to 5 points(HR=2.78,95%CI:1.41-12.96)had a high risk of mortality.Patients with EB viral load≥1000 copies/ml(HR=0.24,95%CI:0.64-0.90)on the RCHOP regimen had a low risk of mortality.In summary,males,ECOG physical status score of 2 to 4 points,IPI score of 3 to 5 points,EB viral load≥1000 copies/ml and HIV viral load≥200 copies/ml are risk factors affecting progression-free survival and overall survival of AIDS-DLBCL patients.RCHOP regimen combined with EB viral load≥1000 copies/ml is a protective factor affecting progression-free survival and overall survival in AIDS-DLBCL patients.