| Objective:To investigating the clinical characteristics of patients with HIV/AIDS-related diffuse large B-cell lymphoma,therapeutic effects under different chemotherapy schemes and possible influencing factors that may affect the prognosis,and provided suggestion for further clinical treatment by retrospective analyze clinical data of patients with HIV/AIDS-related diffuse large B-cell lymphoma.Methods:Retrospective analysis from October 2010 to December 2018,60 adult patients who were first diagnosed as HIV/AIDS related diffuse large B-cell lymphoma and received at least one cycle of chemotherapy were divided into three groups according to the chemotherapy plan:CHOP(cyclophosphamide,doxorubicin,vincristine)with or without R(rituximab)group,(DA)EPOCH(Dose adjustment etoposide,prednisone,vincristine,cyclophosphamide,doxorubicin)with or without R(rituximab)group and other groups,including GEMOX,one case with CMOP(cyclophosphamide,mitoxantrone,vincristine,prednisone),and seven cases with CHOP and/or EPOCH(or reduced the treatment dose,or lack of medicine leads to incomplete plan,or mutual replacement plan,etc.)with or without R(rituximab)group.The basic clinical data,laboratory test results,chemotherapy and therapeutic effect were collected.Results:In this study,60 patients with HIV/AIDS related diffuse large B-cell lymphoma were included.The median age of onset was 46.5 years(25-73 years),most patients occurred between 40-60 years old.The sex ratio of men and women was as high as 5:1.Among the 60 patients,43(71.7%)were diagnosed with lymphoma because of body surface tumor.Lymphoma was found in 11 cases(18.3%).Another 6(10%)patients were diagnosed with lymphoma when they were treated for other reasons.The clinical manifestations of the patients were various,but most of them were progressive enlargement,and 35 patients(58.3%)had B symptoms(fever,weight loss,night sweat,etc.).There were 40 patients with primary lymph nodes,38 with superficial lymph nodes,2 with celiac lymph nodes,and 20 with gastrointestinal tract involvement.In the disease stage,80%of the patients were in stage ?-?,and 35 patients(58.3%)had 2-4 points in ECOG score,41 patients(83.7%)have Ki-67 antigen expression rate?80%.According to the results of immunostaining,56 patients,40 patients with GCB type and 16 patients with Non-GCB type were classified,and 4 patients were not classified.Of the 60 patients,59 received HAART,and only one patient did not receive treatment of HAART.12 patients(20.0%)achieved complete remission,28 patients(46.7%)achieved partial remission,2 patients(3.3%)achieved disease stability,and the CRR of(DA)EPOCH with or without R group was 40.0%,22.2%,17.4%(P=0.387)and ORR of CHOP with or without R group were 80.0%,66.6%respectively 65.2%(P=0.897),it was considered that the CRR and ORR of(DA)EPOCH with or without R group were higher than those of the other two groups,but the difference did not reach the statistical standard.The CRR of CHOP with or without R group in different disease types(unknown,GCB,Non-GCB)was 0%,18.8%,18.2%(P=1>0.05),and the ORR was 33.3%,68.8%,63.0%(P=0.593>0.05),respectively.It was considered that the CRR and ORR of CHOP with or without R group in GCB type were better than those of Non-GCB type group,but the difference was not statistically significant;the CRR and ORR of(DA)EPOCH with or without R group in different disease types(unknown,GCB,non GCB)The CRR of(DA)EPOCH with or without R group was 0%,100%,0%(P=0.2>0.05),and the ORR was 0%,100%,100%(P=0.2>0.05),respectively.It was considered that(DA)EPOCH with or without R group was effective in GCB type or Non-GCB type,and the CRR and ORR in GCB type were 100%.However,there was no significant difference in CRR and ORR between different groups.Among the three chemotherapy regimens,the CRR of R-CHOP and CHOP regimens were 28%,4.8%(P?0.093>0.05),the ORR were 72.0%,57.1%(P=0.292>0.05).The CRR of R-DA-EPOCH and EPOCH were 50%and 0%(P?0.833>0.05),and the ORR were 100%and 0%(P?0.20>0.05).In the other groups,the CRR with and without rituximab was 33.3%and 0%,respectively,while the ORR was 66.7%(P=1>0.05).Therefore,the CRR and ORR of the scheme without rituximab were lower than those of the group with rituximab,but the difference was not up to the statistical standard.In the two-year OS rate comparison of the three groups,(DA)EPOCH with or without R group(75%)was higher than CHOP with or without R group(47.5%)and other treatment groups(37.5%).There was no statistical significance in the two-year OS of the three groups(P=0.603)by log rank test.Univariate analysis showed that the central nervous system invasion,ECOG score,LDH level at the initial diagnosis,efficacy evaluation after first-line chemotherapy,and BCL-2 positive immunohistochemistry may be related to the prognosis(P<0.05).In multivariate analysis,only ECOG score is the only factor that may affect the efficacy(P=0.048).Conclusions:1.There was a significant gender ratio in HIV/AIDS related DLBCL,with the ratio of male to female being 5:1.The age of onset is 40-60 years old male,which can be found both inside and outside the node.The incidence is mainly in the node,and the gastrointestinal tract is mainly involved outside the node.B symptoms are common,with high disease stage,poor physical condition and high tumor cell proliferation rate.2.HAART combined with chemotherapy is the main treatment.There was no significant difference in the therapeutic effect among the three groups.But the trend of CRR and ORR in(DA)EPOCH with or without R group was better than that in other groups and CHOP with or without R group.The therapeutic effect of the three schemes in GCB type group was better than that in Non-GCB type group.For the treatment of Non-GCB type,higher intensity chemotherapy(DA)EPOCH with or without R group has a better therapeutic effect.3.The use of rituximab can improve the efficacy of first-line chemotherapy.4.Univariate analysis showed that the central nervous system invasion,ECOG score,LDH level at the initial diagnosis,efficacy evaluation after first-line chemotherapy,and Bcl-2 positive immunohistochemistry were statistically significant(P<0.05),while in multivariate analysis,ECOG score was the only factor that could affect the efficacy(P=0.048). |
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