title: Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma: an Eastern Cooperative Oncology Group Trial (E1494).
abstract: OBJECTIVE
  To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice.
  
  
  METHODS
  Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m(2)/d, doxorubicin 12.5 mg/m(2)/d, and etoposide 60 mg/m(2)/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group).
  
  
  RESULTS
  Complete response occurred in 44 patients (45%; 95% CI, 35% to 55%). Failure-free survival and overall survival (OS) at 2 years was 36% (95% CI, 26% to 46%) and 43% (95% CI, 33% to 53%), respectively. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P =.039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22% v 42%; P =.037), thrombocytopenia (31% v 52%; P =.033), and anemia (9% v 27%; P =.021), and had fewer treatment-associated deaths (0% v 10%; P =.013).
  
  
  CONCLUSIONS
  Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.
authors.affiliation: Albert Einstein Cancer Center and Montefiore Medical Center, Weiler Division, 1825 Eastchester Road/2 South, Rm 47-48, Bronx, NY 10461, USA. jsparano@montefiore.org
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
authors.forename: Sandra
authors.initials: S
authors.lastname: Lee
authors.forename: Michael G
authors.initials: MG
authors.lastname: Chen
authors.forename: Tipu
authors.initials: T
authors.lastname: Nazeer
authors.forename: Avi
authors.initials: A
authors.lastname: Einzig
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: David H
authors.initials: DH
authors.lastname: Henry
authors.forename: Jane
authors.initials: J
authors.lastname: Manalo
authors.forename: Tianhong
authors.initials: T
authors.lastname: Li
authors.forename: Jamie H
authors.initials: JH
authors.lastname: Von Roenn
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004317:Doxorubicin / Q000627:therapeutic use*; D005047:Etoposide / Q000627:therapeutic use*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy*; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide