TY - JOUR
T1 - A retrospective, multi-center analysis of treatment intensification for human immunodeficiency virus-positive patients with high-risk diffuse large B-cell lymphoma
AU - Kassam, Shireen
AU - Bower, Mark
AU - Lee, Siow Ming
AU - de Vos, Johannes
AU - Fields, Paul
AU - Gandhi, Shreyans
AU - Nelson, Mark
AU - Montoto, Silvia
AU - Tenant-Flowers, Melinda
AU - Burns, Fiona
AU - Marcus, Robert
AU - Edwards, Simon G.
AU - Cwynarski, Kate
PY - 2013/9
Y1 - 2013/9
N2 - This analysis reviews the response rate (RR), treatment toxicity and overall survival (OS) for human immunodeficiency virus (HIV)-positive patients with high-risk diffuse large B-cell lymphoma (DLBCL) and the impact of treatment intensification. Fifty patients, treated with either rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) (n = 35) or cyclophosphamide, vincristine, doxorubicin, methotrexate/etoposide, ifosfamide, cytarabine (CODOX-M/IVAC) +/- R (n = 15) chemotherapy, were included. Baseline characteristics did not differ between the two treatment groups. Forty-seven patients (94%) received rituximab and 48 (96%) received combination anti-retroviral therapy, with chemotherapy. The RR and treatment-related mortality were not significantly different between the two groups. Overall, 68% achieved complete remission. There were significantly more infections and non-hematological toxicities in the CODOX-M/IVAC +/- R group. With a median follow-up of 28 months, 2-year progression-free survival (PFS) and OS are 68% and 70%, respectively, with no significant differences in remission duration, PFS or OS between the groups. In our cohort, the outcome for HIV-positive patients with high-risk DLBCL is favorable. Treatment intensification is feasible, but demonstrated no advantage over R-CHOP.
AB - This analysis reviews the response rate (RR), treatment toxicity and overall survival (OS) for human immunodeficiency virus (HIV)-positive patients with high-risk diffuse large B-cell lymphoma (DLBCL) and the impact of treatment intensification. Fifty patients, treated with either rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) (n = 35) or cyclophosphamide, vincristine, doxorubicin, methotrexate/etoposide, ifosfamide, cytarabine (CODOX-M/IVAC) +/- R (n = 15) chemotherapy, were included. Baseline characteristics did not differ between the two treatment groups. Forty-seven patients (94%) received rituximab and 48 (96%) received combination anti-retroviral therapy, with chemotherapy. The RR and treatment-related mortality were not significantly different between the two groups. Overall, 68% achieved complete remission. There were significantly more infections and non-hematological toxicities in the CODOX-M/IVAC +/- R group. With a median follow-up of 28 months, 2-year progression-free survival (PFS) and OS are 68% and 70%, respectively, with no significant differences in remission duration, PFS or OS between the groups. In our cohort, the outcome for HIV-positive patients with high-risk DLBCL is favorable. Treatment intensification is feasible, but demonstrated no advantage over R-CHOP.
KW - Chemotherapy
KW - diffuse large B-cell lymphoma
KW - high IPI
KW - HIV
KW - ACTIVE ANTIRETROVIRAL THERAPY
KW - NON-HODGKIN-LYMPHOMA
KW - PHASE-II TRIAL
KW - CODOX-M/IVAC
KW - INTENSIVE CHEMOTHERAPY
KW - BURKITTS-LYMPHOMA
KW - RESPONSE CRITERIA
KW - PROGNOSTIC INDEX
KW - PLUS RITUXIMAB
KW - AIDS
U2 - 10.3109/10428194.2012.754024
DO - 10.3109/10428194.2012.754024
M3 - Article
SN - 1042-8194
VL - 54
SP - 1921
EP - 1927
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 9
ER -
