Improved prognosis in patients with acquired immunodeficiency syndrome-related lymphoma.
The purpose of the present study was to evaluate the impact of modern antiretroviral therapy in patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma who were treated with standard chemotherapy. Twenty-nine patients with AIDS were treated with triple antiretroviral therapy, including protease inhibitors, were treated with a chemotherapy regimen involving cyclophosphamide 750 mg/m2, i.v. day 1; vincristine 1.4 mg/m2, i.v. day 1; mitoxantrone 10 mg/m2, i.v. day 1; and bleomycin 10 mg/m2, i.v. day 14. Granulocyte colony stimulating factor 5 ug/kg/day, started on day 5 of every cycle was administered to ameliorate the presence of severe myelosuppression. Complete response (CR) was observed in 21 cases (72%, 95% confidence interval; 63% to 83%). At three years the time to treatment failure (TTF) was 85%; disease free survival (DFS) 62%; and overall survival 55%. Eleven patients died secondary to tumor progression and only three patients died secondary to opportunistic infections. Chemotherapy was well tolerated, only 12% of the cycles developed granulocytopenia grade 3 and eleven episodes of infection-related granulocytopenia were observed. Delay on treatment was observed on 39 cycles (22%) N. death secondary to chemotherapy were recorded.


CONCLUSIONS
The use of modern antiretroviral therapy improved the prognosis of patients with AIDS-related lymphoma, because patients could receive adequate dose intensity of chemotherapy and the presence of opportunistic infections secondary to AIDS declines with the use of protease inhibitors. Future studies will consider the use of more intensive chemotherapy in an aim to improve the CR rate and overall survival.
Avilés
A
A
Department of Hematology/Oncology Hospital, National Medical Center, IMSS, México, D.F. Mexico.
Halabe
J
J
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011379:Prognosis; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D001761:Bleomycin; D019259:Lamivudine; D015215:Zidovudine; D014750:Vincristine; D019469:Indinavir; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D008942:Mitoxantrone