OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press63210.17650/1818-8346-2007-0-3-27-37CLINICAL PICTURE OF HEMATOLOGIC MALIGNANCIESКЛИНИКА ГЕМОБЛАСТОЗОВSomatic problems of HIV-Medicine: AIDS-related lymphomasСоматические проблемы ВИЧ-медицины: СПИД-ассоциированные лимфомыPivnikA. V.ПивникА. В.
Russian Federation

Moscow

Москва

ParhomenkoY. G.ПархоменкоЮ. Г.
Russian Federation

Moscow

Москва

KrivolapovY. A.КриволаповЮ. А.
Russian Federation

St. Petersburg

Санкт-Петербург

TishkevichO. A.ТишкевичО. А.
Russian Federation

Moscow

Москва

KorovushkinV. G.КоровушкинВ. Г.
Russian Federation

Moscow

Москва

KovriginaA. M.КовригинаА. М.
Russian Federation

Moscow

Москва

GrusdevM. B.ГруздевМ. Б.
Russian Federation

Moscow

Москва

GrinshpunL. D.ГриншпунЛ. Д.
Russian Federation

Moscow

Москва

BerdishevaI. A.БердышеваИ. А.
Russian Federation

Moscow

Москва

SereginN. V.СерегинН. В.
Russian Federation

Moscow

Москва

TuaevaA. O.ТуаеваА. О.
Russian Federation

Moscow

Москва

LikunovE. B.ЛикуновЕ. Б.
Russian Federation

Moscow

Москва

BoykoD. V.БойкоД. В.
Russian Federation

Cheliabinsk 

Челябинск 

N.I. Pirogov's National Medico-Surgical Center, Clinic and Chair of hematologyНациональный медико-хирургический центр им. Н.И. ПироговаInfectious City Hospital № 2Клиническая инфекционная больница №2Leningrad Regional Pathology BureauЛОПБN.N. Blokhin's Cancer Research CenterРОНЦ им. Н.Н. Блохина РАМНClinical City Hospital № 60Городская клиническая больница №60Federal Research Center of pediatric hematology, oncology and immunologyФНКЦ ДГОИ РосздраваMedical AcademyМедицинская академия230820073273722112022221120222007https://oncohematology.abvpress.ru/ongm/article/view/632

We followed 66 lymphoma -AIDS patients (pts): aggressive lymphomas were diagnosed in 48 pts (male — 35, female — 13, median age 32.5±1.2) and Hodgkin's lymphoma was established in 18 pts (male — 14, female — 4, median age 34.1±2.3). Median duration time from HIV exposure to the onset of lymphomas was 5 years (2—16 years). A part of pts was receiving HAART. 85 % of pts were drug users and association with HCV was shown in 60 % of them, with HCV and HBV- in 25 %. Sexual transmission was mentioned in 15 % of pts. «Immune status»: CD4 counts were from 50 to 500 (median 225) cells in mcL. Viral load was from 400 to 75000 (median 38000) copies in mcL. Histological diagnosis: diffuse large cell lymphomas — 60%, Burkitt lymphoma — 16%, follicular lymphoma — 12%, MALT-lymphomas-6%, T- cell lymphoma — 4%, primary CNS lymphoma — 2%. CHOP and CHOP-like courses had received 26 pts. Results: 3-year overall survival — 52%, 3-year disease free survival — 32%. Block therapy A-B-C of BFM — NHL— 90 and LB-M-04 with and without Mabthera had received 12 pts. Results: 3-year overall survival — 48%, 3-year disease free survival — 38%. After treatment CD4 count was 60 — 700 (median 316) cells in mcL, viral load 400 to 25000 (median 3000) copies in mcL. 75% of Hodgkin's lymphoma patients had III—IV stages of disease. Initial immune status: CD4 counts from 50 to 730 (median 363) cells in mcL, viral load — from 14000 to 150 000 (median 100 000) copies in mcL. Histological variants: mixed cellularity — 14 pts, lymphoid depletion — 3 pts, nodular sclerosis — 1 pt. Chemotherapy had received 11 pts: ABVD with or without radiotherapy — 8 pts, BEACOPP-escalated with or without radiotherapy — 3 pts. Complete 3-year remissions were achieved in 2 pts. Other pts are on therapy. After treatment CD4 counts were 184 — 900 (median 400) cells in mcL, viral load — 435000 (median 100 000) copies in mcL. Modern treatment approaches in lymphoma -AIDS pts can lead to complete remission, as well as in general non-HIV positive population.

Мы наблюдали 66 больных СПИД-ассоциированными лимфомами: 48 больных агрессивными лимфомами (мужчин 35, женщин 13, соотношение М:Ж 2,6:1; средний возраст 32,5±1,2 года) и 18 больных лимфомой Ходжкина (мужчин 14, женщин 4, соотношение М:Ж 4,5:1; средний возраст 34,1±2,3 года). Основной путь заражения 85% больных – внутривенное введение психотропных средств, 15% – половой. Коинфекция ВИЧ и гепатитов: 60% пациентов с гепатитом С, 25% – с гепатитами В и С. Время от инфицирования ВИЧ до развития лимфом составило в среднем 5 лет (от 2 до 16 лет). Часть больных получали высокоактивную антиретровирусную терапию. Исходный уровень лимфоцитов СD4 225 клеток/мкл (50–500 клеток/мкл), вирусная нагрузка – 38 тыс. копий РНК в 1 мкл (400–75 тыс. копий/мкл). Гистологические варианты лимфом: диффузная крупноклеточная лимфома – 60%, лимфома Беркитта – 16%, фолликулярная лимфома – 12%, МАLTлимфома – 6%, Т-клеточные лимфомы – 4%, первичная лимфома ЦНС – 2%. CHOP и СНОР-подобные курсы получали 26 больных. 3-летняя общая выживаемость составила 52%, безрецидивная выживаемость – 32%. Блоковую терапию по протоколу NHL-BFM-90 и по модифицированной программе ЛБ-04-Москва в сочетании с мабтерой или без получали 12 больных. 3-летняя общая выживаемость – 48%, безрецидивная – 38%. После лечения средний уровень лимфоцитов CD4 составил 316 клеток/мкл (60–700 клеток/мкл), вирусная нагрузка – 3 тыс. копий РНК в 1 мкл (400–25 тыс. копий/мкл). 75% больных лимфомой Ходжкина обратились с IIIB–IV стадиями заболевания. Исходный уровень лимфоцитов СD4 – 363 клетки/мкл (50–730 клеток/мкл), вирусная нагрузка – 100 тыс. копий РНК в 1 мкл (14–150 тыс. копий/мкл). Гистологические варианты лимфомы Ходжкина: смешанно-клеточный – 14 больных, лимфоидное истощение – 3, нодулярный склероз – 1. Лечение проводилось 11 пациентам: ABVD±лучевая терапия – 8, BEACOPP-усиленный c последующей лучевой терапией – 3. Полные ремиссии более трех лет достигнуты у двух больных, остальные пациенты продолжают лечение. После терапии средний уровень лимфоцитов CD4 составил 400 клеток/мкл (184–900 клеток/мкл), вирусная нагрузка –100 тыс. копий РНК в 1 мкл (400–435 тыс. копий/мкл). Использование современных схем лечения больных СПИД-ассоциированными лимфомами приводит к полным ремиссиям, сопоставимым по результатам, полученным у не инфицированных ВИЧ пациентов.

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