HIV 相关 DLBCL 接受 R-CHOP 治疗后的免疫重建及 B 细胞刺激细胞因子的演变

HIV infection is associated with an increased risk of diffuse large B-cell lymphoma (DLBCL). In this prospective study, we analyzed the evolution of B-cell activating cytokines (interleukin-6 [IL-6], IL-10, and B-cell activating factor [BAFF]) and main functional subsets of circulating B and T cells in 51 patients with HIV-associated DLBCL treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, Oncovin [vincristine], and prednisone).

R-CHOP therapy was associated with a decrease of IL-10, whereas IL-6 levels fluctuated, and BAFF levels increased during the first 3 months and decreased thereafter.

We observed a rapid rise in CD19+ B cells composed mostly of naïve B cells whereas marginal zone-like B cells and memory B cells recovered gradually. With a median follow-up of 41 months, progression-free survival and overall survival at 5 years were 61. 8% (95% confidence interval [CI], 47. 6-80. 4) and 67. 4% (95% CI, 53. 4-85.

0), respectively. Progression (17. 5%) and sepsis (12. 5%) were the main causes of death. Baseline risk factors for death and progression were poor revised International Prognostic Index (P = . 049), natural killer cell lymphopenia (P = . 001), lower proportion of naïve B cells (P = . 017), and higher IL-6 serum levels (P = . 001).

Our data suggest that patients treated with R-CHOP for HIV-associated DLBCL have a disturbed peripheral B-cell compartment and that the low pool size of circulating naïve B cells negatively affects their clinical outcome. In an era of development of B-cell-depleting therapies including B-cell-targeting chimeric antigen receptor T cells, assessment of perturbations within nontumoral B-cell counterparts are warranted for risk profiling in HIV-associated DLBCL. This trial was registered at www. ClinicalTrials. gov as #NCT01164436.