Human immunodeficiency virus-associated plasmablastic lymphoma: Poor prognosis in the era of highly active antiretroviral therapy
Human immunodeficiency virus-associated plasmablastic lymphoma: Poor prognosis in the era of highly active antiretroviral therapy
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DOI：
10.1002/cncr.27551
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发表时间：
2012-11-01
期刊：
影响因子：
6.2
通讯作者：
Vose, Julie M.
中科院分区：
文献类型：
--
作者：
Castillo, Jorge J.;Furman, Michael;Vose, Julie M.
背景技术背景：浆母细胞淋巴瘤（PBL）是一种罕见的侵袭性B细胞淋巴瘤，与人类免疫缺陷病毒（HIV）感染密切相关。作者进行了一项多机构的回顾性研究，以描述HIV相关PBL的特征并确定预后因素。方法：在这项研究中，研究人员纳入了2000年至2010年期间诊断的连续HIV阳性患者，这些患者的肿瘤具有浆细胞形态，分化簇20（CD 20）阴性，并表达浆细胞分化标志物。结果：对来自13个机构的50名患者进行了评价。中位年龄为43岁，男性居多。CD 4（一种在辅助性T细胞、单核细胞、巨噬细胞和树突状细胞表面表达的糖蛋白）阳性细胞的中位计数为206个细胞/mm 3。就诊时，90%的患者有结直肠受累，69%的患者有晚期疾病，27%的患者有口腔受累。在41%的受试患者中检测到v-myc骨髓细胞瘤病病毒癌基因同源物（MYC）重排。85%的患者接受化疗，63%接受环磷酰胺、多柔比星、长春新碱和泼尼松，37%接受更强化的方案。完全缓解（CR）率为66%。无论化疗强度如何，中位总生存期（OS）为11个月。在生存分析中，东部肿瘤协作组体力状态=2、晚期和MYC重排与更差的结局显著相关，而化疗达到CR与更好的结局相关。结论：在高效抗逆转录病毒治疗的时代，HIV感染者PBL的预后仍然很差。强化化疗方案似乎并不能提高HIV相关PBL患者的生存率。癌症2012年。(c)2012年美国癌症协会
BACKGROUND: Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell lymphoma strongly associated with human immunodeficiency virus (HIV) infection. The authors conducted a multi-institutional, retrospective study to describe characteristics and determine prognostic factors in HIV-associated PBL. METHODS: For this study, the investigators included consecutive, HIV-positive patients diagnosed between the years 2000 and 2010 whose tumors had a plasmablastic morphology, were cluster of differentiation 20 (CD20)-negative, and expressed markers of plasmacytic differentiation. RESULTS: Fifty patients from 13 institutions were evaluated. The median age was 43 years, and there was a male predominance. The median count of cells that were positive for CD4 (a glycoprotein expressed on the surface of T-helper cells, monocytes, macrophages, and dendritic cells) was 206 cells/mm3. At presentation, 90% of patients had extranodal involvement, 69% presented with advanced stage disease, and 27% had oral involvement. Rearrangements of v-myc myelocytomatosis viral oncogene homolog (MYC) were detected in 41% of the tested patients. Eighty-five percent of patients received chemotherapy, with 63% receiving cyclophosphamide, doxorubicin, vincristine, and prednisone and 37% receiving more intensive regimens. The complete response (CR) rate was 66%. The median overall survival (OS) was 11 months regardless of the intensity of chemotherapy. In the survival analysis, an Eastern Cooperative Oncology Group performance status =2, advanced stage, and MYC rearrangements were associated significantly with a worse outcome, whereas attaining a CR with chemotherapy was associated with a better outcome. CONCLUSIONS: The prognosis of PBL in HIV-infected individuals remains poor in the highly active antiretroviral therapy era. Intensive chemotherapy regimens do not seem to increase survival in patients with HIV-associated PBL. Cancer 2012. (c) 2012 American Cancer Society.