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Lymphoma

Liposomal Doxorubicin, Cyclophosphamide, and Etoposide and Antiretroviral Therapy for Patients with AIDS-Related Lymphoma: A Pilot Study

^a University of Washington School of Medicine, Seattle, Washington, USA; ^b Ovation Research Group, Highland Park, Illinois, USA, and University of Washington School of Public Health, Seattle, Washington, USA; ^c Virginia Mason Medical Center, Seattle, Washington, USA

Key Words. Non-Hodgkin’s lymphoma • HIV/AIDS • Antiretroviral therapy • Chemotherapy

Correspondence: David M. Aboulafia, M.D., Section of Hematology/Oncology, Virginia Mason Medical Center, 1100 Ninth Avenue, P.O. Box 900 (H14-HEM), Seattle, Washington 98111, USA. Telephone: 206-341-1284; Fax: 206-223-6914; e-mail: hemdma{at}vmmc.org

Purpose. To evaluate in a pilot study the safety and efficacy of liposomal doxorubicin, cyclophosphamide, and etoposide (LACE) when combined with antiretroviral therapy (ART) in patients with AIDS-related lymphoma (ARL). The impact of HIV viral control on therapy and survival was also assessed.

Patients and Methods. Between 1994 and 2005, 40 patients at Virginia Mason Medical Center were diagnosed with ARL. Twelve received LACE every 28 days. All patients received intrathecal chemoprophylaxis, ART, and G-CSF.

Results. The median patient CD4⁺ count was 190 cells/µl (range, 20–510 cells/µl), and the median HIV viral load (VL) was 61,613 copies/ml (range, <50–500,000 copies/ml). Seven patients (58%) had an International Prognostic Index score of 3 or 4. Six patients (50%) were ART-naïve, five were viremic despite ART, and one had an undetectable HIV-1 VL. Nine patients (75%) achieved a complete response (CR), and median overall survival was 107 months. At a median follow-up of 46 months, the recurrence-free survival rate was 50%. Two patients died from relapsed/refractory ARL and one patient achieved a CR with salvage therapy. One CR patient died from complications of pneumonia, and another CR patient died from uncertain causes 5 years after treatment. Grade 3 or 4 neutropenia occurred in 23 of 61 (38%) chemotherapy cycles. Hospitalization was required after 5% of treatment cycles due to neutropenic fever.

Conclusion. LACE is an effective and tolerable treatment for ARL. HIV viral control can be maintained in the majority of patients during and after completion of LACE.