Outcomes of HIV-associated Burkitt Lymphoma in Brazil: High treatment toxicity and refractoriness rates - A multicenter cohort study
Outcomes of HIV-associated Burkitt Lymphoma in Brazil: High treatment toxicity and refractoriness rates - A multicenter cohort study
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DOI：
10.1016/j.leukres.2019.106287
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发表时间：
2020-02-01
影响因子：
2.7
通讯作者：
Rocha, Vanderson
中科院分区：
文献类型：
--
作者：
da Silva, Wellington F.;Marques Garibaldi, Pedro Manoel;Rocha, Vanderson
背景：尽管联合抗逆转录病毒疗法 (cART) 的使用增加已降低了 HIV 相关淋巴瘤的发病率，但伯基特淋巴瘤 (BL) 的发病率仍保持稳定。发达国家关于 HIV 相关 BL 的报告结果似乎证实了治疗方案不需要针对 HIV 阳性人群进行调整。 材料和方法：这是一项来自巴西的回顾性多中心队列研究，包括 15 岁及以上诊断为 BL 的 HIV 阳性患者。 结果：总共纳入 54 名患者。中位年龄为 39 岁（范围：15-64 岁）。诊断时，86% 的患者发现晚期疾病，52% 的患者 CD4+ 计数低于 200 个细胞/mm(3)。五名患者在开始任何治疗方案之前死亡。其余 49 名患者中，大多数接受 Hyper-CVAD（53%）和 CODOX-M IVAC（18%）治疗。仅 16% 的患者在一线使用利妥昔单抗。 14%发现原发性难治性疾病。治疗相关死亡率为 38.7%，完全缓解率为 44.9%。 4 年时，估计总生存率 (OS) 为 39.8%。所有复发和原发难治性患者最终均死亡。尽管进行了抗菌药物预防和相关的 cART，其余患者还是死于感染 (24/34)。结论：我们的队列中的早期死亡率和毒性高于发达国家。更快的诊断、更好地了解该疾病的生物学、建立低毒性治疗方案、纳入利妥昔单抗和改善支持性护理可能会降低发展中国家艾滋病毒相关 BL 的死亡率。
Background: Although the increased use of combined antiretroviral therapy (cART) has decreased the incidence of lymphomas HIV-associated, Burkitt lymphoma (BL) incidence remains stable. Reported outcomes on HIV-associated BL from developed countries seem to corroborate that the regimens do not need to be tailored to the HIV-positive population.Materials and methods: This is a retrospective multicenter cohort study from Brazil, including HIV-positive patients aged 15 years and above diagnosed with BL.Results: A total of 54 patients were included. Median age was 39 years (range, 15-64). At diagnosis, advanced disease was found in 86% and 52% had a CD4+ count lower than 200 cells/mm(3). Five patients died before starting any regimen. Among the remaining 49 patients, most were treated with Hyper-CVAD (53%) and CODOX-M IVAC (18%). Rituximab was used in frontline in only 16% of the patients. Primary refractory disease was found in 14%. A treatment-related mortality of 38.7% and a complete response rate of 44.9% were found. At 4 years, estimated overall survival (OS) was 39.8%. All relapsed and primary refractory patients eventually died. Remaining patients died from infections (24/34), despite antimicrobial prophylaxis and associated cART.Conclusion: Early mortality and toxicity were higher in our cohort than in developed countries. A faster diagnosis, better understanding of the biology of the disease, establishment of low toxicity regimens, inclusion of rituximab and improvement of supportive care may decrease the mortality of HIV-associated BL in developing countries.