Excellent immunological recovery following CODOX-M/IVAC, an effective intensive chemotherapy for HIV-associated Burkitt's lymphoma.
OBJECTIVE
: To retrospectively describe the recovery of cellular immunity and the clinical outcome of 30 patients with HIV-associated Burkitt's lymphoma (HIV-BL), who were treated with the intensive chemotherapy CODOX-M/IVAC and HAART as part of their standard care.


METHODS
: Seventy-three percent of the patients had high-risk disease, defined by stage, performance status, extranodal sites and lactate dehydrogenase. The median CD4 cell count at diagnosis of HIV-BL was 171/ml (range: 4-848) and the plasma HIV viral load was undetectable in five of 29 patients.


RESULTS
: Nine patients died during treatment (disease progression, three; toxicity, five; central nervous system lesion not biopsied, one). Response rate was 70% (complete response/complete response uncertain, 17; partial response, 4). After a median follow-up of 22 months (range: 6-72), 18 patients remain alive without disease progression. The 3-year overall survival and event-free survival were 52 and 75%, respectively. Viral load was undetectable in 88% and CD4 cell count more than 200/ml in 58% of patients assessed 6 months after completing chemotherapy, and in 87 and 80% at 12 months, respectively.


CONCLUSIONS
: The intensive regimen CODOX-M/IVAC, a feasible and effective chemotherapy, is associated with an excellent immunological recovery in patients with HIV-BL on HAART.
Montoto
Silvia
S
CR-UK Medical Oncology Unit, St Bartholomew's Hospital, Barts and the London School of Medicine and Dentistry, UK. s.montoto@qmul.ac.uk
Wilson
Jamie
J
Shaw
Kate
K
Heath
Maureen
M
Wilson
Andy
A
McNamara
Christopher
C
Orkin
Chloe
C
Nelson
Mark
M
Johnson
Margaret
M
Bower
Mark
M
Cwynarski
Kate
K
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D018791:CD4 Lymphocyte Count; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate