HIV-RELATED NON-HODGKINS-LYMPHOMA - CHOP INDUCTION THERAPY AND INTERFERON-ALPHA-2B ZIDOVUDINE MAINTENANCE THERAPY/

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.