63例HIV相关弥漫大B细胞淋巴瘤临床特征及预后分析：国内单中心真实世界研究

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.