Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
TREATMENT OF NON-HODGKIN'S LYMPHOMAS (NHL) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) (MEETING ABSTRACT)
Fifteenth Symposium of the International Association for Comparative Research on Leukemia and Related Diseases. October 6-11, 1991, Padova/Venice, Italy, p. 30, 1991.. Unique Identifier : AIDSLINE ICDB/92682386 Gisselbrecht C; Tirelli U; Oksenhendler E; Gabarre J; Gastaldi R; Farcet JP; Lepage E; Raphael M; Monfardini S; GELA-GICAT, Inserm-CNR study, Hopital Saint-Louis, Paris 75010,; France
Abstract:
NHL HIV patients (pts) have a poor prognosis related to lymphoma and HIV infection. To evaluate whether a subset of pts could be treated with intensive chemotherapy, a pilot study was initiated based on a clinical stratification. Pts were stratified in 2 risk groups: group A, no opportunistic infection (OI) and performance status (PS) less than 3; group B, PS greater than 2 or existence of OI. In group A, pts were treated with the intensive and brief regimen LNH 84 (J Clin Oncol, August 1989) associated with prophylactic cranial radiotherapy. AZT was given after the induction phase. In group B, pts received a low-dose chemotherapy program with cyclophosphamide 300 mg/m2 day (d) 1, Adriamycin 25 mg/m2 d 1, VM26 30 mg/m2 d 1, vincristine 1.4 mg/m2 d 15, bleomycin 10 mg/m2 d 15, and prednisone. AZT 600 mg was started with chemotherapy. In case of CNS involvement, cranial irradiation was used. In group A, 145 pts have been included, 101 are evaluable. Histology was diffuse large cell 35 pts, immunoblastic 17 pts, Burkitt's 33 pts, and unclassified 16 pts. Stage distribution was I-IE 20 pts, II-IIE 21 pts, III-IV 60 pts. B symptoms 51 pts, bulky tumor 31 pts. Extranodal involvement greater than 2, 39 pts; bone marrow 23 pts; meningeal 22 pts. LDH greater than normal value, 76 pts. Prior AIDS 16%, T4 less than 100 34%. AgP24 39%. After induction, 67% were in CR, 21% PR or failure, 11% died. Hematotoxicity with neutropenia less than 0.5/mm3 was constant, with prolonged cytopenia in 10 pts. 40% experienced infection greater than grade 2. 79% of the pts received 100% of the dose; however, mean interval between cycles was 21 d. Median disease-free survival was 12 mo, median survival 9 mo. 54 pts died, 20 in CR, 28 from NHL. Factors adversely influencing the probability of survival were absence of complete remission, B symptoms, prior AIDS. In group B, 24 pts were included, complete response rate was only 20%. Median survival was 2.6 mo. In pts with good PS and no OI, LNH 84 regimen can achieve a CR rate similar to standard NHL; however, after induction, about half of the pts died from infection. In order to improve the tolerance to such intensive treatment, a pilot study with the use of GM-CSF associated with low-dose AZT is ongoing.
Keywords: Antineoplastic Agents, Combined/ADVERSE EFFECTS Bleomycin/THERAPEUTIC USE Cyclophosphamide/THERAPEUTIC USE Doxorubicin/THERAPEUTIC USE Human Infection/CHEMICALLY INDUCED Lymphoma, AIDS-Related/*DRUG THERAPY/MORTALITY/RADIOTHERAPY Neutropenia/CHEMICALLY INDUCED Pilot Projects Prednisone/THERAPEUTIC USE Vincristine/THERAPEUTIC USE Zidovudine/*THERAPEUTIC USE ABSTRACT 920830
M9281085
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Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
