Fax: (011) 33 4 91 22 36 10
Intensive sequential chemotherapy with hematopoietic growth factor support for non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus
Article first published online: 12 JAN 2004
Copyright © 2004 American Cancer Society
Volume 100, Issue 4, pages 667–676, 15 February 2004
How to Cite
Costello, R. T., Zerazhi, H., Charbonnier, A., de Colella, J.-M. S., Alzieu, C., Poizot-Martin, I., Cohen, R., Bardou, V.-J., Xerri, L., Olive, D., Nezri, M., Lepeu, G. and Gastaut, J.-A. (2004), Intensive sequential chemotherapy with hematopoietic growth factor support for non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus. Cancer, 100: 667–676. doi: 10.1002/cncr.20019
- Issue published online: 3 FEB 2004
- Article first published online: 12 JAN 2004
- Manuscript Revised: 14 NOV 2003
- Manuscript Accepted: 14 NOV 2003
- Manuscript Received: 19 SEP 2003
- Fondation de France
- Association pour la Recherche contre le Cancer
- Fondation Contre la Leucémie
- Fondation pour la Recherche Médicale
- dose escalation;
- acquired immunodeficiency syndrome;
- human immunodeficiency virus–associated non-Hodgkin lymphoma
Optimal treatment of human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL) has yet to be defined, because chemotherapy could exacerbate immunodeficiency, with subsequent adverse effects for patients.
The authors investigated the feasibility of an intensive chemotherapy regimen for HIV-associated NHL. Thirty-eight patients were treated with a first course of cyclophosphamide (Cy), vincristine, and prednisone; followed by 3 courses of high-dose Cy (2000 mg/m2), doxorubicin (Doxo; 50 mg/m2), vincristine, and prednisone (modified high-dose CHOP); 1 course of high-dose methotrexate (MTX; 8000 mg/m2); and 1 course of high-dose cytarabine (8000 mg/m2). Radiotherapy was added to the treatment regimen for patients with bulky disease or residual tumor. Chemotherapy was administered in conjunction with granulocyte–colony-stimulating factor and antiretroviral therapy.
Patients received 91.5%, 93%, 66%, and 63% of the scheduled doses of Cy, Doxo, MTX, and cytarabine, respectively. The complete response rate was 60.5%, with a total response rate of 79%. The 40-month overall survival rate was 43%, the disease-free survival rate was 65%, and the recurrence-free survival rate was 39%. Both an International Prognostic Index score of 0 or 1 and Burkitt-type histology had positive effects on survival, whereas CD4-positive lymphocyte counts, viral burden, and previous highly active antiretroviral therapy did not. CD4-positive T lymphocyte levels decreased from 0.197 ± 0.156 ×109/L before treatment to 0.152 ± 0.1 ×109/L at 6 months after the end of treatment. A decrease in viral load, from 380,000 ± 785,000 copies/mL before treatment to 25,000 ± 43,000 copies/mL at 6 months after the end of treatment, also was observed.
The results of the current study indicate that intensive chemotherapy is effective and tolerable for patients with HIV-associated NHL. Cancer 2004;100:667–76. © 2004 American Cancer Society.