Outcome of patients with relapsed/refractory acquired immune deficiency syndrome-related lymphoma diagnosed 1999-2008 and treated with curative intent in the AIDS Malignancy Consortium.
No comparative studies exist for relapsed/refractory (rel/rfr) acquired immune deficiency syndrome (AIDS)-related lymphoma (ARL). To determine practices over the last decade and to assess the outcomes of salvage chemotherapy with curative intent and autologous stem cell transplant (ASCT), we retrospectively evaluated treatment outcomes in patients with rel/rfr ARL who were treated in 13 national AIDS Malignancy Consortium (AMC) sites between 1999 and 2008 (n = 88). The most commonly used second-line therapies were ICE (ifosfamide/carboplatin/etoposide, n = 34), dose adjusted EPOCH (etoposide/prednisone/vincristine/cyclophosphamide/doxorubicin, n = 17) and ESHAP (etoposide/methylprednisolone/cytarabine/cisplatin, n = 11). The odds of achieving a response were lower for those with non-Hodgkin lymphoma (NHL) than for those with HL and for those with primary refractory disease than for those with relapse. Overall survival (OS) was significantly longer for those with relapsed disease compared to those with refractory disease and for those with non-Burkitt NHL compared to those with Burkitt. OS was longer in patients who underwent ASCT compared to those who did not (1-year OS: 63.2% vs. 37.2%). However, among 32 patients (36%) who achieved a complete or partial response (CR/PR) after second-line therapy, 1-year OS was not different between the two groups (87.5% for ASCT vs. 81.8% for non-ASCT). Long-term survival in some patients with rel/rfr ARL may be possible without transplant, although transplant remains the standard of care for chemotherapy sensitive disease.
Division of Hematology/Oncology, University of Miami, Miami, FL, USA.
Ulas D
UD
Bayraktar
Juan Carlos
JC
Ramos
Adam
A
Petrich
Neel
N
Gupta
Shelly
S
Lensing
P C
PC
Moore
Erin G
EG
Reid
David M
DM
Aboulafia
Lee
L
Ratner
Ronald
R
Mitsuyasu
Timothy
T
Cooley
David H
DH
Henry
Paul
P
Barr
Ariela
A
Noy
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003131:Combined Modality Therapy; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000139:chemically induced; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000379:methods*; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000139:chemically induced; D014182:Transplantation, Autologous; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult