Phase II Trial of Infusional Cyclophosphamide, Doxorubicin, and Etoposide in Patients With HIV-Associated Non-Hodgkin’s Lymphoma: An Eastern Cooperative Oncology Group Trial (E1494)

• Published in: Journal of clinical oncology Vol. 22; no. 8; pp. 1491 - 1500
• Main Authors: SPARANO, Joseph A, LEE, Sandra, CHEN, Michael G, NAZEER, Tipu, EINZIG, Avi, AMBINDER, Richard F, HENRY, David H, MANALO, Jane, TIANHONG LI, VON ROENN, Jamie H
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 15.04.2004; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Cyclophosphamide - therapeutic use; Doxorubicin - therapeutic use; Etoposide - therapeutic use; Hematologic and hematopoietic diseases; Human viral diseases; Humans; Infectious diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, AIDS-Related - drug therapy; Medical sciences; Middle Aged; Prognosis; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Antineoplastic agent; Doxorubicin; Isomerases; Association; Lymphoproliferative syndrome; Phase II trial; Clinical trial; Immunopathology; DNA topoisomerase (ATP-hydrolysing); Enzyme; Retroviridae; Etoposide; Enzyme inhibitor; AIDS; Malignant hemopathy; Non Hodgkin lymphoma; Immune deficiency; Lentivirus; Infection; Virus; Podophyllotoxine derivatives; Alkylating agent; Cyclophosphamide; Oxazaphosphinane derivatives; Viral disease; Nitrogen mustard; Anthracyclins; Human immunodeficiency virus
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2004.08.195

To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice. Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m(2)/d, doxorubicin 12.5 mg/m(2)/d, and etoposide 60 mg/m(2)/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group). Complete response occurred in 44 patients (45%; 95% CI, 35% to 55%). Failure-free survival and overall survival (OS) at 2 years was 36% (95% CI, 26% to 46%) and 43% (95% CI, 33% to 53%), respectively. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P =.039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22% v 42%; P =.037), thrombocytopenia (31% v 52%; P =.033), and anemia (9% v 27%; P =.021), and had fewer treatment-associated deaths (0% v 10%; P =.013). Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.