比较不同方案治疗艾滋病相关伯基特淋巴瘤的疗效和安全性分析：一项单中心回顾性研究

doi:10.3969/j.issn.1006-7795.2025.03.005

摘要/Abstract

摘要： 目的评估剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星联合利妥昔单抗方案（dose-adjusted etoposide, doxorubicin and cyclophosphamide with vincristine, prednisone and rituximab without radiotherapy，DA-EPOCH-R）对比改良的利妥昔单抗、环磷酰胺、长春新碱、阿霉素、大剂量甲氨蝶呤、亚叶酸钙（cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, CODOX-M)/异环磷酰胺、依托泊苷、大剂量阿糖胞苷联合利妥昔单抗（ifosfamide, etoposide, high-dose cytarabine and rituximab，IVAC-R）方案治疗艾滋病（acquired immune deficiency syndrome，AIDS）相关伯基特淋巴瘤（burkitt lymphoma，BL）患者的疗效和安全性。方法本研究为一项单中心回顾性队列研究，纳入2010年12月至2022年6月期间于首都医科大学附属北京地坛医院诊断为艾滋病相关伯基特淋巴瘤患者41例，26例患者接受DA-EPOCH-R方案治疗（观察组），15例患者接受改良CODOX-M/IVAC-R方案治疗（对照组），收集患者的临床特征、实验室检查、不良反应和临床疗效，采用多变量Cox比例风险模型评估预后相关风险因素。结果 41例入组患者中， 97.6%为男性，中位年龄为43岁，41.5%的患者基线中位CD4⁺细胞计数低于200个/ μL。中位随访17个月，观察组患者的完全缓解（complete response，CR）率显著高于对照组（57.7% vs. 33.3%）,观察组患者中位总生存期（overall survival, OS）与对照组相比差异有统计学意义，分别为18.0个月和6.7个月（95%CI：5.0~16.6）（P <0.001）；而观察组治疗相关的病死率却显著低于对照组（0% vs 26.7%，P<0.01）。结论 DA-EPOCH-R方案治疗AIDS相关伯基特淋巴瘤较改良CODOX-M/IVAC-R方案具有更优的生存获益且安全性良好，可作为该类患者的优选化学药物治疗方案。

关键词: 伯基特淋巴瘤, 艾滋病, DA-EPOCH-R方案, 改良CODOX-M/IVAC-R方案, 疗效和安全性

Abstract: Objective To evaluate the efficacy and safety of the dose-adjusted etoposide, doxorubicin and cyclophosphamide with vincristine, prednisone and rituximab without radiotherapy (DA-EPOCH-R) regimen versus the modified cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M/IVAC-R) regimen in the treatment of patients with acquired immune deficiency syndrome (AIDS)-related Burkitt lymphoma (BL). Methods This single-center retrospective cohort study included 41 patients diagnosed with AIDS-related BL at Beijing Ditan Hospital, Capital Medical University, from December 2010 to June 2022. Among them, 26 patients received the DA-EPOCH-R regimen (observation group), and 15 patients received the modified CODOX-M/IVAC-R regimen (control group). Clinical characteristics, laboratory findings, toxicities, and treatment outcomes were analyzed. Prognostic risk factors were assessed using a multivariate Cox proportional hazards model. Results Of the 41 enrolled patients, 97.6% were male, with a median age of 43 years. The baseline median CD4+ cell count was below 200 cells/ μL in 41.5% of patients. After a median follow-up of 17 months, the complete response (CR) rate was significantly higher in the observation group compared to the control group (57.7% vs 33.3%). The median overall survival (OS) was also significantly prolonged in the observation group (18.0 months) versus the control group (6.7 months, 95% CI: 5.0－16.6) (P<0.001). Treatment-related mortality was notably lower in the observation group (0% vs. 26.7%, P<0.01). Conclusion Compared to the modified CODOX-M/IVAC-R regimen, the DA-EPOCH-R regimen demonstrates superior survival benefits and enhanced safety in the treatment of AIDS-related BL, suggesting it as the preferred chemotherapy option for this patient population.

Key words: Burkitt lymphoma, acquired immune deficiency syndrome, DA-EPOCH-R regimen, modified CODOX-M/IVAC-R regimen, efficacy and safety

中图分类号:

R512.91，R733.4

王庆莲, 滕颖, 乔文赢, 陈京龙, 丁晓燕. 比较不同方案治疗艾滋病相关伯基特淋巴瘤的疗效和安全性分析：一项单中心回顾性研究[J]. 首都医科大学学报, 2025, 46(3): 427-435.

Wang Qinglian, Teng Ying, Qiao Wenying, Chen Jinglong, Ding Xiaoyan. Comparative analysis of efficacy and safety of different regimens in the treatment of AIDS-related Burkitt lymphoma: a single-center retrospective study[J]. Journal of Capital Medical University, 2025, 46(3): 427-435.

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