Low dose methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone with zalcitabine in patients with acquired immunodeficiency syndrome-related lymphoma. Effect on human immunodeficiency virus and serum interleukin-6 levels over time.

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Cancer. 1996 Aug 1;78(3):517-26. Unique Identifier : AIDSLINE MED/96320583
Levine AM; Tulpule A; Espina B; Boswell W; Buckley J; Rasheed S; Stain S; Parker J; Nathwani B; Gill PS; Department of Medicine, Division of Hematology, University of; Southern California School of Medicine, Los Angeles, USA.

Abstract: BACKGROUND: Use of multiagent chemotherapy has been associated with complete remission (CR) in approximately 50% of patients with newly diagnosed acquired immunodeficiency syndrome (AIDS)-lymphoma, although additional AIDS-related complications may occur. Both chemotherapy and antiretroviral therapy were employed in an attempt to ascertain if the combination was safe, and associated with changes in human immunodeficiency virus (HIV) p24 antigen levels during the course of treatment. METHODS: Low dose methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone(M-BACOD) chemotherapy and zalcitabine (ddC) were employed in 28 patients. Since both vincristine and zalcitabine may cause peripheral neuropathy, a Phase I/II study design was employed. Serum was analyzed for immune complex dissociated (ICD) HIV p24 antigen and interleukin (IL)-6 levels during therapy. RESULTS: CR was achieved in 14 of 25 patients (56%), with partial response (PR) in 5 (20%). CRs were equivalent in patients with good or poor prognostic indicators, including a history of AIDS prior to lymphoma (CR = 60%); and/or CD4 lymphocytes < 200/mm3 (CR = 53%). Five patients with a CR subsequently relapsed (36%); median survival of CR patients was 29.2 months (4.1-61+), whereas that of all of the treated patients was 8.1 months. No significant peripheral neuropathy or other toxicity was observed. Serum ICD p24 antigen levels either fell (7/14) or remained consistently negative (2/14) in 9 of 14 patients (64%), whereas 36% experienced an increase. Elevated serum IL-6 levels at diagnosis were associated with systemic B symptoms (P = 0.023), whereas changes in IL-6 correlated with response to therapy over time (P = 0.006). CONCLUSIONS: Combination antineoplastic and zalcitabine antiretroviral therapy may be safely administered to patients with AIDS-related lymphoma, resulting in CR in 56%, lack of significant neurotoxicity, and favorable effect on HIV p24 antigen in 50%. Elevation of serum IL-6 is associated with systemic B symptoms, whereas changes in serum IL-6 may correlate with response.

Keywords: Acquired Immunodeficiency Syndrome/BLOOD/DRUG THERAPY/*VIROLOGY Adult Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE Antiviral Agents/ADVERSE EFFECTS/*THERAPEUTIC USE Bleomycin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Cyclophosphamide/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Dexamethasone/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Doxorubicin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Human HIV Core Protein p24/ANALYSIS HIV-1/*ISOLATION & PURIF Interleukin-6/*BLOOD Leucovorin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Lymphoma, AIDS-Related/BLOOD/*DRUG THERAPY Male Methotrexate/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Middle Age Peripheral Nervous System Diseases/CHEMICALLY INDUCED Remission Induction Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Vincristine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Zalcitabine/ADVERSE EFFECTS/*THERAPEUTIC USE CLINICAL TRIAL CLINICAL TRIAL, PHASE I CLINICAL TRIAL, PHASE II JOURNAL ARTICLE
961130
M96B1848

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