Weekly alternating combination chemotherapy for good prognosis AIDS-related lymphoma

Early studies reported that the major adverse prognostic factors in AIDS-re lated non-Hodgkin's lymphoma (ARL) are low CD4 cell count, prior AIDS defin ing diagnosis and poor performance status. Since 1989 we have adopted a pro gnosis-stratified approach for ARL. In this study, we identified a group of good prognosis patients. These patients with one or no adverse prognostic factors were treated with alternating weekly chemotherapy using the bleomyc in, etoposide, vincristine, methotrexate, prednisolone/cyclo-phosphamide do xorubicin (BEMOP/CA) schedule (Bower M, Block C, Gulliford T. ct ill. Cance r Chemother Pharmacol 1995, 38, 106-109). Modifications to the regimen with the aim of reducing toxicity were a briefer duration (12 weeks) and the ad dition of prophylaxis against pneumocystis and mycobacteria. Intrathecal me thotrexate was administrated fortnightly to patients with Burkitt's histolo gy, meningeal involvement or base of skull disease. 30 patients were treate d, including 5 with prior AIDS, 3 with ECOG status 3 and 1 with CD4 < 100/m u l. The mean age was 40 (range 22-60 years), the median CD4 cell count at ARL diagnosis was 262/mu l (range 44-588/mu l). The International non-Hodgk in's lymphoma (NHL) prognostic factors project classifications were lon ris k 8 (maximum 5.4 years) (27%), low-intermediate risk 6 (20%), high-intermed iate risk 11 (37%) and high risk 5 (17%). The median follow-up was 2.1 year s. 3 patients withdrew from treatment within I weeks due to toxicity, 2 pat ients died within 2 weeks of starting chemotherapy. The major toxicity was myelosuppression with 14 patients developing grade 3 neutropenia. The 2-yea r overall survival rate is 46% (95% confidence interval (CI) = 27-65%), and lymphoma-specific survival at ? years is 59% (95% CI: 40-78%). For selecte d patients with good prognosis ARL 12 weeks BEMOP/CA therapy produces good overall survival at 2 years. (C) 2000 Elsevier Science Ltd. All rights rese rved.