Oral combination chemotherapy in the management of AIDS-related lymphoproliferative malignancies

An oral combination chemotherapy regimen initially developed for AIDS-relat ed non-Hodgkin's lymphoma includes lomustine (CCNU), etoposide, cy clophosp hamide, and procarbazine. This regimen takes advantage of oral administrati on, the in vitro synergy of these drugs and their first-line efficacy in ly mphoma, and the ability of lomustine and procarbazine to cross the blood-br ain barrier. This regimen was used to treat 38 patients with AIDS-related n on-Hodgkin's lymphoma. The overall objective response rate was 66% (34% com plete response rate) with a 5% CNS relapse rate, and a median survival dura tion of 7.0 months. One-third of the patients survived for 1 year, 11% for 2 years, and half of the: patients survived free from progression of their lymphoma. On the basis of these results, this oral regimen was modified and administered to 5 patients with AIDS-related primary CNS lymphoma as part of a sequential combined-modality chemotherapy and radiation regimen. Rapid progression of CNS disease was observed in this group of patients, with a median survival duration of 1.0 month. The identical regimen was administer ed to 7 patients with AIDS-related Hodgkin's disease: we observed a 71% par tial remission rate and a median survival duration of 7.0 months. Myelosupp ression remains the most significant clinical toxicity. Our results with th is oral regimen appear comparable to those of standard intravenous combinat ion chemotherapy regimens in patients with AIDS-related non-Hodgkin's lymph oma.