HIV相关结外NK/T细胞淋巴瘤，鼻型：一例病例报告及文献复习

文献信息

中文摘要

结外NK/T细胞淋巴瘤（ENKTCL）是一种罕见的侵袭性淋巴瘤，其治疗因HIV-1合并感染而变得复杂，原因在于药物-药物相互作用和重叠毒性，特别是化疗方案与ART同时使用所致的肝肾和血液学毒性汇聚。我们报告一名中年HIV-1阳性男性（CD4+ T细胞：198/μL，HIV-1 RNA：9.70×10³拷贝/mL），患有IE期ENKTCL鼻型，其最初的鼻塞被反复误诊为鼻窦炎。基于整合酶链转移抑制剂（INSTIs）的ART无法负担，且依非韦伦因既往过敏而禁忌，因此不得不继续使用基于洛匹那韦/利托那韦的ART，尽管其具有CYP3A4抑制作用。多学科团队指导同步治疗，给予两个全剂量周期的P-GemOxD（吉西他滨、培门冬酶、奥沙利铂、地塞米松），随后进行巩固性放疗（20次）。患者耐受治疗，未发生≥3级不良事件。治疗后PET-CT证实完全代谢缓解，HIV-1 RNA检测不到。在9个月随访时，缓解持续存在，CD4+ T细胞升至255/μL。本病例表明，在无法获得基于INSTI的方案时，MDT模式为使用非INSTI类药物给予全剂量P-GemOxD化疗提供了一个实用的管理框架。我们的经验为管理HIV与恶性肿瘤并发的治疗复杂性提供了参考策略。

英文摘要

Extranodal NK/T-cell lymphoma (ENKTCL) is a rare aggressive lymphoma whose management is complicated by HIV-1 co-infection due to drug-drug interactions and overlapping toxicities, specifically the convergent hepatorenal and hematological toxicities resulting from the concurrent use of chemotherapeutic regimens and ART. We report a middle-aged HIV-1 positive man (CD4+ T cells:198/μL, HIV-1 RNA:9.70×10³ copies/mL) with stage IE ENKTCL nasal type, whose initial nasal congestion was repeatedly misdiagnosed as sinusitis. An integrase strand transfer inhibitor-based (INSTIs) ART was unaffordable, and efavirenz was contraindicated by prior allergy, necessitating continuation of lopinavir/ritonavir-based ART despite its CYP3A4 inhibition. A multidisciplinary team guided concurrent therapy with two full-dose cycles of P-GemOxD (gemcitabine, pegaspargase, oxaliplatin, dexamethasone) followed by consolidative radiotherapy (20 fractions). The patient tolerated treatment without grade ≥ 3 adverse events. Post-therapy PET-CT confirmed complete metabolic response, with HIV-1 RNA undetectable. At 9-month follow-up, remission persisted and CD4+ T cells rose to 255/μL. This case illustrates that an MDT model offers a practical management framework for delivering full-dose P-GemOxD chemotherapy with non-INSTIs when INSTI-based regimens are not accessible. Our experience provides a reference strategy for managing the therapeutic complexities of concurrent HIV and malignancy.