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Post-HAART HIV+ NHL Patients Benefit From Chemotherapy

Post-HAART HIV+ NHL Patients Benefit From Chemotherapy

SAN FRANCISCO—HIV-positive patients with non-Hodgkin’s lymphoma
(NHL) should not be excluded from chemotherapy or given a limited-dose regimen,
Joseph Sparano, MD, said at the 37th Annual Meeting of the American Society of
Clinical Oncology (ASCO abstract 1172).

He reported that failure-free survival and overall survival rates improved
in these patients after the introduction of highly active antiretroviral
therapy (HAART).

Investigators from the Eastern Cooperative Oncology Group had already begun a study of infusional chemotherapy for patients with HIV-associated NHL
when HAART became available, said Dr. Sparano, of Albert Einstein College of
Medicine and Montefiore Medical Center, Bronx, New York. Consequently, the
researchers were able to compare 48 patients who did not receive HAART with 59
post-HAART patients.

"The prognosis of patients with non-Hodgkin’s lymphoma who are HIV
positive may not be so dismal," Dr. Sparano told ONI, citing his findings
and those from an Italian group that also reported improved outcomes post-HAART. "HIV infection in and of itself should not be a
reason to exclude patients with lymphoma from potentially life-saving
chemotherapy."

The ECOG trial is closed, but patients continue to be monitored. Both
cohorts had a median age of 39. Post-HAART patients presented with a median CD4
count of 227/µL vs 78/µL in the earlier group. Lymphoma was diagnosed at
stage III/IV in 82% of pre-HAART and 72% of post-HAART patients.

Treatment Regimens

All received cyclophosphamide (200 mg/m²/d), doxorubicin (12.5 mg/m²/d), and
etoposide (VePesid) (60 mg/m²/d) by continuous intravenous infusion for 96
hours plus filgrastim (Neupogen) for six to eight cycles.

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