title: Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma.
abstract: Rituximab plus intravenous bolus chemotherapy is a standard treatment for immunocompetent patients with B-cell non-Hodgkin lymphoma (NHL). Some studies have suggested that rituximab is associated with excessive toxicity in HIV-associated NHL, and that infusional chemotherapy may be more effective. We performed a randomized phase 2 trial of rituximab (375 mg/m(2)) given either concurrently before each infusional etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy cycle or sequentially (weekly for 6 weeks) after completion of all chemotherapy in HIV-associated NHL. EPOCH consisted of a 96-hour intravenous infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by intravenous bolus cyclophosphamide given every 21 days for 4 to 6 cycles. In the concurrent arm, 35 of 48 evaluable patients (73%; 95% confidence interval, 58%-85%) had a complete response. In the sequential arm, 29 of 53 evaluable patients (55%; 95% confidence interval, 41%-68%) had a complete response. The primary efficacy endpoint was met for the concurrent arm only. Toxicity was comparable in the 2 arms, although patients with a baseline CD4 count less than 50/microL had a high infectious death rate in the concurrent arm. We conclude that concurrent rituximab plus infusional EPOCH is an effective regimen for HIV-associated lymphoma.
authors.affiliation: Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY 10461, USA. jsparano@montefiore.org
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
authors.forename: Jeannette Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Kaplan
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ramos
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: William
authors.initials: W
authors.lastname: Wachsman
authors.forename: David
authors.initials: D
authors.lastname: Aboulafia
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: David H
authors.initials: DH
authors.lastname: Henry
authors.forename: Jamie
authors.initials: J
authors.lastname: Von Roenn
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Dezube
authors.forename: Scot C
authors.initials: SC
authors.lastname: Remick
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Shah
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leichman
authors.forename: Lee
authors.initials: L
authors.lastname: Ratner
authors.forename: Ethel
authors.initials: E
authors.lastname: Cesarman
authors.forename: Amy
authors.initials: A
authors.lastname: Chadburn
authors.forename: Ronald
authors.initials: R
authors.lastname: Mitsuyasu
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006678:HIV / Q000502:physiology*; D006801:Humans; D007262:Infusions, Intravenous; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone