Long-term survival in patients with human immunodeficiency virus-associated small non-cleaved cell lymphoma: the role for short course intensive chemotherapy.
While intensive chemotherapy is recommended for the treatment of non-HIV related adult small non-cleaved lymphoma (SNCL), including Burkitt's and Burkitt-like lymphoma, optimal treatment for patients with HIV-associated SNCL is not known. We assessed remissions and survival in a cohort of 44 consecutive HIV positive patients diagnosed with SNCL at our hospital between June 2000 and November 2001 using chart and pathology data. Median follow-up, survival and survival at the median follow-up time were 4.5 months, 4 months and 49% respectively. Of this cohort 39% were complete responders (CR) and 36% were long-term lymphoma-free survivors. Two patients relapsed from CR. Short course intensive chemotherapy (McMaster) was administered to 23 patients; 17 received less intensive conventional combination chemotherapy; and four received single-agent chemotherapy or no treatment. In the McMaster group, 38% (9/23) achieved CR with no relapses. Seven patients (30%) died of toxicity compared with one (6%) in the less intensively treated group. Of the stage I patients, 75% (6/8) achieved long-term CR with half being treated conventionally. Conventional chemotherapy may be curative for early stage HIV-SNCL. In advanced disease, McMaster chemotherapy was found to be associated with substantial early mortality but was curative in a significant number of patients.
Department of Medicine, Sections of Hematology and Oncology and Comprehensive Cancer Center, Saint Vincent's Catholic Medical Center Manhattan, New York, NY 10011, USA. aastrow@salick.com
Alan B
AB
Astrow
Grace
G
Tarabay
Vincent E
VE
Salerno
William A
WA
Cook
Robert
R
Lin
Steven
S
Lascher
Zujun
Z
Li
Amitabha
A
Mazumder
Ira
I
Halperin
John
J
Cho
Zulfaqquar
Z
Jaffar
Marilyn
M
McLaughlin
Ronald H
RH
Blum
Sanford J
SJ
Kempin
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002051:Burkitt Lymphoma / Q000821:virology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome