Treatment of HIV-related Lymphoma
Prior to HAART, the outcome for patients with HIV-related lymphoma was inferior to that in the non-HIV-infected population. The use of conventional chemotherapy schedules at full dose resulted in marked toxicity and an increased incidence of opportunistic infections in HIV-related lymphoma. In an attempt to decrease chemotherapy toxicity, modified regimes, such as methotrexate/bleomycin/doxorubicin/cyclophosphamide/vincristine/dexamethasone, were used by the AIDS clinical trials group in the 1980s.[26] However, the reduced number of doses in these schedules resulted in higher rates of relapse. The introduction of HAART improved immune status, reduced the incidence of opportunistic infections and allowed the use of more aggressive chemotherapy strategies. The Phase II Eastern Cooperative Oncology Group trial (E1494) investigated the use of infusional cyclophosphamide, doxorubicin and etoposide (CDE) and demonstrated that up to 30% of patients with adverse prognostic features could be cured when treated with full-dose therapy plus G-CSF support.[27] These findings were mirrored by Bower et al. as well as by the German Lymphoma Study Group, which used a risk-stratified approach for simultaneous treatment with HAART and combination cyclophosphamide, doxorubicin, vincristine and prednisolone.[28,29] Furthermore, in a retrospective, multicenter cohort study of HIV-related BL or Burkitt-like lymphoma diagnosed between 1990 and 2004, Hoffman et al. confirmed that treatment with aggressive cytotoxic regimes significantly prolonged survival (hazard ratio [HR]: 0.13; 95% CI: 0.03–0.63; p = 0.01).[30]
HIV Ther. 2010;4(6):649-659. © 2010 Future Medicine Ltd.
Cite this: HIV-related Lymphoma - Medscape - Nov 01, 2010.
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