Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
VP16, mitoxantrone and prednimustine (VMP): an effective palliative chemotherapy (CT) regimen in patients (pts) with relapsed HIV-related non-Hodgkin's lymphoma (HIV-NHL) (Meeting abstract).
Proc Annu Meet Am Assoc Cancer Res; 14:A828 1995. Unique Identifier : AIDSLINE ICDB/95613980 Errante D; Gastaldi R; Nigra E; Nosari AM; Magnani G; Vaccher E; Bernardi D; Tirelli U; Italian Cooperative Group on AIDS and Tumors, CRO, Aviano, Italy
Abstract:
There is no experience published in the literature on the feasibility and activity of second line CT in pts with relapsed or resistant HIV-NHL. Nineteen pts with resistant or relapsed HIV-NHL were consecutively treated from April 1992 and October 1994. We employed VMP, a regimen specifically devised and safely used at our Institution in elderly pts with unfavorable NHL of the general population (U Tirelli et al, JCO 10:228-36; 1992). V and P were both given orally at doses of 80 mg/m2 for 5 days, and M was given iv at dose of 10 mg/m2 on day 1; cycles were repeated every three weeks. All pts received Pneumocystis Carinii pneumonia prophylaxis and any antiretroviral therapy that their physicians thought to be appropriate. Granulocyte-colony stimulating factor (G-CSF) was given sc at the dose of 5 ug/kg/day beginning at day 6 at discretion of the treating physician in pts experiencing severe granulocytopenia in the previous cycle. The median age of the pts was 32 years (24-55), 14 of them were males and 5 females. Ten pts were intravenous drug users, 5 homosexual men and 2 heterosexuals. ECOG PS was as follows: 0/1/2/3 = 1/4/8/6. Histology: G/H/J/miscellaneous = 4/7/6/2. All but one pt have received CHOP or CHOP-like regimens as first line CT. The overall absolute CD4+ cell median count at VMP start was 77/mm3 (range 3-588). Of the 19 pts who entered the study, 2 were not assessable for response: 1 for early death and 1 for toxic death after the first cycle. The median number of cycles actually administered was 2 (range 1-5). Complete remission (CR) occurred in 5 out of 17 (29%) pts. In particular only 1 CR, of 6 mo duration, occurred out of 11 evaluable pts with resistant NHL, while 4 CRs of 3+, 5, 6, 6+ mo duration, occurred out of 6 evaluable pts with relapsed NHL. We observed only 2 partial responses: 1 in relapsed pts group and 1 in resistant pts group. Nine out of 10 pts with no response belonged to the resistant group. The toxic effects of VMP consisted predominantly of myelosuppression. Out of 40 evaluable cycles for toxicity, severe neutropenia (less than 500/ul) occurred in 14 (35%) cycles; severe thrombocytopenia (less than 25,000 u/l) occurred in 3 (7%) cycles. We observed the previous mentioned toxic death due to a septic shock during severe neutropenia in a pt with resistant NHL. However G-CSF was not employed in this pt. Overall median survival was 2 mo (range less than 1-13); median survival in pts with relapsed NHL was 7 mo (range less than 1-13), significantly longer (p = 0.02) than in pts with resistant NHL (2 mo; range less than 1-6) . In conclusion, although the overall prognosis of pts with resistant and relapsed HIV-NHL is very poor, an effective and relatively safe palliative approach with VMP can be offered to pts who have relapsed after first line CT, with some occasional pts surviving for several mo.
Keywords: Adult Antineoplastic Agents, Combined/TOXICITY/*THERAPEUTIC USE CD4 Lymphocyte Count Etoposide/ADMINISTRATION & DOSAGE Female Homosexuality, Male Human Lymphoma, AIDS-Related/*DRUG THERAPY/IMMUNOLOGY/MORTALITY/ PATHOLOGY Male Middle Age Mitoxantrone/ADMINISTRATION & DOSAGE Palliative Care Prednimustine/ADMINISTRATION & DOSAGE Recurrence Substance Abuse, Intravenous Survival Rate ABSTRACT CLINICAL TRIAL 951230
M95C3209
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
