Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Human immunodeficiency virus-related lymphoma treatment with intensive combination chemotherapy (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 12:A1227 1993. Unique Identifier : AIDSLINE ICDB/94695626 Gisselbrecht C; Lepage E; Tirelli U; Oksenhendler E; Gabarre J; Farcet JP; Gastaldi R; Coiffier B; Thyss A; Rapahel M; et al; Hematology Inst., Saint Louis Hosp., Paris, France
Abstract:
An increased risk of high-grade non-Hodgkin's lymphoma is observed in patients (pts) who are seropositive for human immunodeficiency virus (HIV). Treatment of such patients is complicated by their underlying acquired immunodeficiency syndrome (AIDS). Pts without severe AIDS may derive significant benefits from intensive therapy. In a prospective study, treatment outcomes were assessed in 141 cases of HIV-seropositive lymphomas. Methods: Adult lymphoma pts with a performance status less than 3 and no active opportunistic infection were consecutively treated with 3 cycles of doxorubicin 75 mg/m2, cyclophosphamide 1200 mg/m2, vindesine 2 mg/m2, x 2, bleomycin 10 mg x 2 and prednisolone 60 mg/m2 x 5 (ACVB). This treatment was followed by a consolidation phase of high-dose methotrexate + leucovorin, ifosfamide, etoposide, asparaginase and cytarabine (LNH84). CNS prophylaxis with intrathecal methotrexate was routinely used. Zidovudine maintenance was started after chemotherapy. 93 pts had high-grade lymphomas (59 Burkitt's), 48 had intermediate grade. Stage III-IV was present in 86 pts, meningeal involvement in 29 and bone marrow infiltration in 30; 62 pts had more than 2 extranodal localizations. LDH were above the normal value in 95 cases. The median CD4-positive lymphocyte count was 227 x 10(6)/L. Results: 89 pts (63%) achieved complete remission (CR) and 19 (13%) partial remission, while 13 failed to respond and 20 (14%) died during the course of ACVB, 8 of them from progressive disease. With a median follow-up of 28 months, median survival and disease-free survival were 9 and 16 months, respectively. Median survival for nonresponders was 5 months; 23 pts died of opportunistic infections while in persistent CR. In multivariate analysis, 4 factors were strongly associated with shorter survival: (1) CD4 less than 100 x 10(6)/L, (2) performance status greater than 1, (3) immunoblastic lymphoma and (4) prior AIDS. In the absence of all risk factors, the probability of survival at 2 years was 50%. Conclusion: In a selected group of HIV-related lymphomas, intensive chemotherapy with LNH84 is feasible and yields a high CR rate. Survival is short, due to death from HIV-related infections. However, in a subgroup of patients without adverse prognostic factors, long-term remission was observed.
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Adult Antineoplastic Agents, Combined/*THERAPEUTIC USE Asparaginase/ADMINISTRATION & DOSAGE Cytarabine/ADMINISTRATION & DOSAGE Etoposide/ADMINISTRATION & DOSAGE Human Ifosfamide/ADMINISTRATION & DOSAGE Leucovorin/ADMINISTRATION & DOSAGE Lymphoma, Non-Hodgkin's/COMPLICATIONS/*DRUG THERAPY/MORTALITY Methotrexate/ADMINISTRATION & DOSAGE Remission Induction Survival Analysis ABSTRACT 940228
M9420824
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
