R. Weiss et al., HIV-RELATED NON-HODGKINS-LYMPHOMA - CHOP INDUCTION THERAPY AND INTERFERON-ALPHA-2B ZIDOVUDINE MAINTENANCE THERAPY/, Leukemia & lymphoma, 29(1-2), 1998, pp. 103-118
In a prospective multicenter study 68 out of 158 patients with HIV inf
ection and malignant lymphoma were assigned to a risk-adapted inductio
n therapy using the following algorithm: High-risk patients fulfilled
2 of 3 criteria: T4 lymphocytes <50/mu L; WHO activity index 3 or 4; p
re-existing AIDS-defining opportunistic infection, Normal-risk patient
s received 4 to 6 cycles of CHOP chemotherapy; those that achieved com
plete remission (CR) received zidovudine (500 mg/d) and interferon-alp
ha maintenance therapy (5 million units three times a week) for one ye
ar. High-risk patients received low-dose CHOP or vincristine/prednison
e chemotherapy. Supportive care was performed with pentamidine inhalat
ion and G-CSF. Intrathecal (it) methotrexate was given for CNS prophyl
axis. The median survival was 634 days for 38 patients of the normal-r
isk group and 129 clays for 30 patients of the high-risk group. 18 hig
h-risk patients treated with low-dose CHOP had better survival (156 da
ys) than 12 patients treated with vincristine/prednisone (72 days p =
0.044). 68% of the patients in the normal-risk group achieved complete
remission. 5 out of 18 high-risk patients treated with low-dose CHOP
achieved complete remission. Three normal-risk patients developed fata
l opportunistic infections during chemotherapy. Immune parameters dete
riorated after CHOP induction and partially recovered with maintenance
treatment. We conclude that the normal-risk patients survived longer
than reported in most published studies. Toxicity was low, Low-dose CH
OP seems to be superior to vincristine/prednisone therapy in high-risk
patients.