TREATMENT OF AIDS-RELATED NON-HODGKINS-LYMPHOMA WITH CHEMOTHERAPY (CNOP) AND R-HN-G-CSF - CLINICAL OUTCOME AND EFFECT ON HIV-1 VIRAL LOAD

Purpose: The optimal treatment of AIDS-related NHL (ARL) has yet to be defined. The purpose of this study was 1) to evaluate the efficacy an d toxicity of the CNOP-regimen (cyclophosphamide, mitoxantrone, vincri stine, and prednison) in combination with G-CSF; and 2) to study the e ffect of this regimen on HIV-1 viral replication. Patients and methods : A phase II study was performed in 21 previously untreated patients w ith ARL. Results. Based on intention to treat, the response rate was 4 3%: four complete and five partial remissions. Median survival was onl y five months. Only one patient had an opportunistic infection during treatment; three patients had localized infections and one episode of septicaemia was seen. Remarkably, during treatment, in 94% of cases p2 4 antigen levels either remained undetectable or showed a substantial decrease, even though antiretroviral therapy had been discontinued jus t prior to the first cycle of chemotherapy in all patients. HIV-1 RNA load decreased or remained unchanged in 82% of patients and increased in three patients. Conclusions. Our data demonstrate, 1) that the CNOP -regimen in combination with G-CSF, although associated with a low ris k of both opportunistic and bacterial infections, can not be recommend ed in the treatment of ARL; but 2) that G-CSF can be used safely to su stain haematopoiesis in patients with ARL treated with chemotherapy.