Клиническая характеристика и результаты лечения ВИЧ-ассоциированной диффузной В-крупноклеточной лимфомы

Clinical Features and Treatment Outcomes of HIV-Associated Diffuse Large B-Cell Lymphoma

BACKGROUND. One of the most life-threatening complications of HIV-associated infections is a considerable increase in the risk of malignant neoplasms (MNP). Non-Hodgkin lymphomas, in particular diffuse large B-cell lymphoma (DLBCL), being the most common form of MNP in HIV-positive subjects, pose a serious threat to their lives. AIM. To compare the clinical features, treatment methods and outcomes of DLBCL in HIV-positive and HIV-negative patients. MATERIALS & METHODS. The study is based on the clinical data of 384 primary DLBCL patients, among them 60 (15.6 %) HIV-positive subjects (HIV-DLBCL), treated at the AF Tsyb Medical Radiological Research Center in the period from 2018 to 2025. By the time of antiretroviral therapy (ART) onset, HIV stage III was identified in 6 (10 %) patients and HIV stage IV was detected in 54 (90 %) patients. Prior to chemotherapy, all patients received ART, which resulted in viral load suppression in 15 (25 %) cases. Chemotherapy for DLBCL included commonly R-CHOP, R-mini-CHOP, and R-EPOCH (other protocols were used very rarely). In HIV-DLBCL patients, R-EPOCH (R-CODOX-M/R-IVAC in 1 case) was administered. All 60 HIV-DLBCL patients received prophylaxis to prevent CNS damage. RESULTS. In contrast to the total DLBCL population, in HIV-DLBCL group there were more men (60.0 % and 46.9 %, respectively), higher rate of intoxication symptoms (41.7 % vs. 29.6 %) and stage IV of the disease (83.35 % vs. 67.0 %) as well as higher LDH level (68.3 % vs. 53.4 %) and tumor lesions in bone marrow (28.3 % vs. 19.1 %). Although extranodal involvements were found in both groups and accounted for 81.7 % and 82.7 %, respectively, HIV-DLBCL patients showed more extranodal zones (≥ 3 simultaneously), i.e., 31.7 % vs. 12.9 %, respectively. Conversely, a more aggressive non-GCB subtype was reported in HIV-DLBCL patients more rarely (55.3 % vs. 74.9 %). Between DLBCL and HIV-DLBCL patients, no significant differences were found concerning either the rate of complete responses to chemotherapy (67.9 % vs. 58.3 %; p = 0.15) or 2-year progression-free survival (78.7 % vs. 74.6 %; p = 0.468) and overall survival (91.9 % vs. 89.6 %; p = 0.554). HIV-positive patients showed significantly higher rate of hematologic toxicity in all hematopoietic lineages (p < 0.001), hepatotoxicity (p < 0.001), as well as febrile neutropenia and infectious complications (p < 0.001). CONCLUSION. The efficacy of treatment for HIV-positive patients is not inferior to that for the total DLBCL population. Younger HIV-DLBCL patients can be treated with more intensive chemotherapy programs with prophylaxis against CNS damage. The major condition for therapy success is an early treatment assignment of adequate ART with monitoring of drug-drug interactions as well as supportive therapy and complete prevention of infectious complications. © «Практическая медицина»