Objective: This study aimed to look into the clinical characteristics and prognosis of patients with human immunodeficiency virus (HIV) -associated diffuse large B-cell lymphoma (DLBCL) . Methods: Retrospective review of the clinical data of 63 HIV-infected patients with DLBCL diagnosed at Chongqing University Cancer Hospital between July 2008 and August 2021. The Kaplan-Meier method was used to calculate survival curves, and the log-rank test method was used to compare survival between groups. The Cox proportional hazards model was used for multivariate analysis. Results: In 63 patients with HIV-associated DLBCL, 57 (90.5% ) were men, and the median age was 49 (23-87) years. The most common pathological subtype was the germinal center B-cell-like lymphoma (74.6% ) ; 46.0% (29/63) were combined with extranodal lesions. Seventeen of 63 (27.0% ) patients had large masses (≥7.5 cm) . Twenty of 63 (31.7% ) patients had B symptoms. The median CD4(+) T cell count was 203 (4-1022) ×10(6)/L. A total of 49% (25/51) patients had CD4(+) cell count <200×10(6)/L, 56.9% (33/58) had high (3-5) International Prognostic Index (IPI) scores, and 43.1% (25/58) had low (0-2) IPI scores. Further, 78% (46/59) were diagnosed with Ann Arbor Stage Ⅲ/Ⅳ, and 25.4% (16/63) didn't receive chemotherapy. A total of 22.2% (14/63) of patients received less than four cycles of chemotherapy, and 52.4% (33/63) received four or more cycles of chemotherapy. Among patients undergoing chemotherapy, 61.7% (29/47) received R-CHOP-like regimens, and 38.3% (18/47) used CHOP-like regimens. The 1-, 2-, 3-, and 5-year overall survival (OS) rates were 65.0% , 53.8% , 47.1% , and 43.5% , respectively. Univariate analysis revealed that age ≥ 60 years (P=0.012) , Eastern Cooperative Oncology Gruop Performance Status (ECOG-PS) score 2-4 points (P=0.043) , IPI score 3-5 points (P=0.001) , β(2)-MG elevation (≥5.5 mg/L) (P=0.007) , and systemic chemotherapy cycles less than four times (P<0.001) were the negative prognostic factors affecting the OS of patients. The Cox multivariate analysis depicted that age ≥60 years (HR=2.272, 95% CI 1.110-4.651, P=0.025) , IPI score 3-5 points (HR=3.562, 95% CI 1.794-7.074, P<0.001) , ECOG-PS score 2-4 points (HR=2.675, 95% CI 1.162-6.153, P=0.021) , and number of cycles of chemotherapy<4 (HR=0.290, 95% CI 0.176-0.479, P<0.001) were independent risk factors for adverse prognosis of OS. Conclusion: HIV-associated DLBCL is the most common HIV-related tumor, is most commonly seen in men, and has a high 1-year mortality rate. Chemotherapy combined with antiretroviral therapy can improve patient prognosis.
目的： 探讨HIV相关弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征及预后。 方法： 回顾性分析2008年7月至2021年8月重庆大学附属肿瘤医院确诊的63例HIV相关DLBCL患者的临床资料。生存分析采用Kaplan-Meier方法，组间生存的比较采用Log-rank检验，多因素分析采用Cox回归模型。 结果： 63例患者中，男57例（90.5%），中位年龄49（23~87）岁。主要病理类型为生发中心来源（GCB），为47例（74.6%）。29例（46.0%）患者合并淋巴结外病变，17例（27.0%）患者合并大包块（最大直径≥7.5 cm），20例（31.7%）患者伴随B症状。CD4(+)淋巴细胞中位数为203（4~1022）×10(6)/L，49%（25/51）的患者CD4(+)细胞数<200×10(6)/L，51%（26/51）的患者CD4(+)细胞数≥200×10(6)/L。43.1%（25/58）的患者IPI评分0~2分，56.9%（33/58）的患者IPI评分3~5分。78%（46/59）的患者Ann Arbor分期Ⅲ/Ⅳ期。16例（25.4%）患者未接受化疗，14例（22.2%）患者接受小于4个周期的化疗，33例（52.4%）患者接受4个周期及以上的化疗。在接受化疗的患者中，61.7%（29/47）的患者采用R-CHOP样方案，38.3%（18/47）的患者采用CHOP样方案。总体患者的1、2、3和5年总生存（OS）率分别为65.0%、53.8%、47.1%和43.5%。单因素分析显示年龄≥60岁（P＝0.012）、美国东部肿瘤协作组体能状况（ECOG-PS）评分2~4分（P＝0.043）、IPI评分3~5分（P＝0.001）、β(2)-微球蛋白升高（P＝0.007）和全身化疗周期数<4（P<0.001）为影响患者OS的不良预后因素。Cox多因素分析显示年龄≥60岁（HR＝2.272，95%CI 1.110~4.651，P＝0.025）、IPI评分3~5分（HR＝3.562，95%CI 1.794~7.074，P<0.001），ECOG-PS评分2~4分（HR＝2.675，95%CI 1.162~6.153，P＝0.021）和化疗周期数<4（HR＝0.290，95%CI 0.176~0.479，P<0.001）为影响OS的预后危险因素。 结论： HIV相关DLBCL是最常见的HIV相关肿瘤，男性多见，1年内病死率高，化疗联合抗逆转录病毒治疗可显著改善患者预后。.
Keywords: Acquired immune deficiency syndrome; Clinical characteristics; Human immunodeficiency virus; Lymphoma, large B-cell, diffuse; Prognosis.