Analysis of clinical features and prognostic factors of AIDS-related lymphoma
Yahong Gong1, Xiaoming Gong2, Kai Zhang3, Lu Song4, Yipan Li4, Hengning Ke5, ZhiYan Lu4
1 Department of Obstetrics and Gynecology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China
2 Department of Radiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning; Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
3 Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
4 Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
5 Department of Infectious Diseases, Hubei AIDS Clinical Training Central, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
Prof. Hengning Ke
Hubei AIDS Clinical Training Central, Zhongnan Hospital of Wuhan University, Wuhan, Hubei
Dr. ZhiYan Lu
Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei
Source of Support: None, Conflict of Interest: None
OBJECTIVE: To analyze the clinical characteristics, pathological characteristics, and prognostic factors of AIDS-related lymphoma (ARL).
MATERIALS AND METHODS: This was a retrospective study of the clinical characteristics, diagnosis and treatment process, and survival status of 32 patients with ARL. The patients were divided into a survival group and nonsurvival group according to their prognosis, and the factors affecting survival were analyzed. The patients' clinical characteristics were analyzed according to symptoms, sex, age, and laboratory indicators such as the lactate dehydrogenase (LDH) concentration, number of CD4+ T cells, Ann Arbor stage, pathological typing, and international prognostic index (IPI) score. A univariate regression analysis was performed to compare the clinical characteristics of the treatment group and nontreatment group. The impact of chemotherapy and combined antiviral therapy on survival time was assessed.
RESULTS: Thirty-two patients were included in the study; 31 were male and 23 were aged >40 years. The average LDH concentration was 639.8 U/L, and the average CD4+ lymphocyte count was 167 cells/μL. Diffuse large B-cell lymphoma was present in 40.6% (13/32) of the patients; a B-lymphocyte source accounted for 90.6% (29/32) of cases, and a T-lymphocyte source accounted for 9.4% (3/32). The proportion of patients who received anti-lymphoma treatment was 84.4% (27/32). Twenty-three patients died during follow-up and nine survived. Univariate analysis showed that the prognostic factors were age, the CD4+ T-lymphocyte count, and the IPI score. The average progression-free survival (PFS) time in the highly active antiretroviral therapy (HAART) group before chemotherapy was 4.81 months, while the average PFS time without antiviral therapy before chemotherapy was about 1.91 months. This difference was statistically significant. The median 2-year survival time in patients who received antiviral therapy before chemotherapy was 33.3 months, while that in patients who did not receive antiviral therapy was 27.3 months. Early HAART therapy combined with standardized chemotherapy was shown to improve the patients' prognosis. It also improved the overall survival (OS) rate and PFS time. However, there was no significant difference in the OS rates between 1 and 2 years.
CONCLUSION: The CD4+ T-cell count and IPI score were key factors affecting the prognosis of patients with ARL. An increased LDH concentration was also a prognostic factor. A certain correlation between the disease severity and prognosis was found. The use of standard anti-lymphoma treatment can effectively improve the survival rate of patients.