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