[Clinical Study of Chemotherapy Combined with Antivirals for Adult T-cell Leukemia/Lymphoma]

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Oct;30(5):1407-1414. doi: 10.19746/j.cnki.issn.1009-2137.2022.05.016.
[Article in Chinese]

Abstract

Objective: To investigate the efficacy of chemotherapy combined with antivirals in adult T-cell leukemia/lymphoma (ATLL) patients and the prognostic factors.

Methods: Forty nine patients with previously treated or treatment-nave ATLL from January 2018 to January 2021 were included in our study. The patients were divied into two groups according to whether they received antiviral treatment, twenty-seven patients were treated with chemotherapy combined with antivirals, including thirteen patients treated with recombinant interferon alpha-2b and CHOP therapy, eight patients treated with zidovudine combined with CHOP therapy, and 6 patients treated with CHOP regimen combined with interferon and zidovudine. Twenty-two patients were treated with CHOP therapy. The changes of symptom, hematological parameters, lactic dehydrogenase, β2-microglobulin, and the Ki-67 positive rate were compared between the two groups before and after treatments. The clinical efficacy of chemotherapy combined with antiviral therapy for ATLL was evaluated. The antiviral effect was assessed by detecting HTLV-1 virus copy number, and prognostic factors were analyzed.

Results: The median follow-up time was 14 months. Compared with the patients treated with chemotherapy alone, the patients treated with chemotherapy combined with antivirals had lower tumor and virus loads, lower white blood cell count, lower lactate dehydrogenase level, lower β2-microglobulin lever, and lower Ki-67 positive rate (all P<0.05). The total effective rate of patients treated with chemotherapy combined with antivirals was significantly higher than those of patients treated with chemotherapy alone (63.0% vs 31.8%, P=0.035). The one-year overall survival (OS) rates of chemotherapy combined with antivirals groups and chemotherapy alone group were (74.1±2.9)% and (40.9±2.1)% (P=0.021), respectively. The one-year progress free survival (PFS) rates were (51.9±3.3)% and (13.6±2.8)% (P=0.017), respectively. Multivariable Cox regression analysis showed that HTLV-1 virus load (HR=7.518, 95%CI: 2.517-36.192, P=0.013) and antiviral therapy [HR=5.617 (95%CI 1.803-11.293), P=0.027] were independent prognostic factors for the long-term efficacy.

Conclusion: Addition of antivirals to chemotherapy can prolong PFS and OS in ATLL patients. HTLV-1 virus load and antiviral therapy are independent prognostic factors for ATLL patients.

题目: 化疗联合抗病毒治疗成人T细胞白血病/淋巴瘤的临床研究.

目的: 探讨化疗联合抗病毒治疗成人T细胞白血病/淋巴瘤的疗效及相关预后因素.

方法: 将2018年1月至2021年1月收治的49例既往确诊或新诊断的成人T细胞白血病/淋巴瘤患者纳入研究。根据是否行抗病毒治疗将患者分为2组,化疗联合抗病毒治疗组27例,其中13例用重组人α-2b干扰素联合CHOP方案治疗,8例用齐多夫定联合CHOP方案化疗,6例采用CHOP方案联合干扰素加齐多夫定治疗;单纯化疗组22例,单用CHOP治疗。通过比较2组患者治疗前后症状、血常规、LDH、β2微球蛋白、Ki-67等指标变化,评估化疗联合抗病毒治疗ATLL的临床疗效,检测HTLV-1病毒拷贝数以评价抗病毒的效果,并进行相关预后因素分析.

结果: 中位随访时间为14个月。与单纯化疗相比,经化疗联合抗病毒治疗患者肿瘤负荷较治疗前明显减轻,HTLV-1病毒拷贝数明显下降,白细胞数、LDH、β2-MG、Ki-67阳性率及HTLV-1病毒量等指标均明显降低(P<0.05);化疗联合抗病毒组总有效率(CR+PR)明显高于单纯化疗组(63.0% vs 31.8%, P=0.035)。化疗联合抗病毒组、单纯化疗组患者1年总生存率分别为(74.1±2.9)%和(40.9±2.1)%(P=0.021),1年无进展生存率分别为(51.9±3.3)%和(13.6±2.8)%(P=0.017)。多因素分析结果显示,HTLV-1病毒量及是否抗病毒治疗为影响患者远期疗效的独立危险因素(HR=7.518, 95%CI: 2.517-36.192, P=0.013; HR=5.617, 95%CI: 1.803-11.293, P=0.027).

结论: ATLL化疗基础上加用抗病毒可提高其疗效,延长其无进展生存时间及总体生存时间,HTLV-1病毒量及是否抗病毒治疗可影响患者长期预后.

Keywords: CHOP therapy; adult T-cell leukemia-lymphoma; efficacy; interferon; zidovudine.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Antiviral Agents / therapeutic use
  • Cyclophosphamide
  • Doxorubicin
  • Humans
  • Interferon alpha-2 / therapeutic use
  • Ki-67 Antigen
  • Lactate Dehydrogenases
  • Leukemia-Lymphoma, Adult T-Cell* / drug therapy
  • Lymphoma* / drug therapy
  • Oxidoreductases / therapeutic use
  • Vincristine / therapeutic use
  • Zidovudine / therapeutic use

Substances

  • Antiviral Agents
  • Interferon alpha-2
  • Ki-67 Antigen
  • Zidovudine
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Oxidoreductases
  • Lactate Dehydrogenases