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9th Annual Conference Of The British HIV Association [BHIVA]24 – 26 April 2003, University of Manchester
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[AUTHOR(S):] C Thirlwell, J Stebbing, MR Nelson, BG Gazzard and M Bower
Chelsea and Westminster Hospital, London, UK
BHIVA Conf 2003 Apr 24-26;9:O13
BACKGROUND: Since 1999 the standard therapy in our unit for systemic AIDS-related lymphoma has been infusional cyclophosphamide/doxorubicin/ etoposide (CDE), which has the potential for overcoming Pglycoprotein- mediated drug resistance, with highly active antiretroviral therapy (HAART).
METHODS: C is given at 800 mg/m2 IVI over 96 hours (200 mg/ 24 hours), D at 50 mg/m2 IVI over 96 hours (12.5 mg/24 hours) and E at 240 mg/m2 IVI over 96 hours (60 mg/24 hours). This is given monthly for up to six cycles with granulocyte colony-stimulating factor support, opportunistic infection prophylaxis and intrathecal chemoprophylaxis.
RESULTS: 30 patients (27 male) (median age 46 years, range 27–60) were enrolled. The median interval between HIV-1 diagnosis and that of non-Hodgkins lymphoma (NHL) was 53 months (range 0–175) and all received HAART (nine a protease inhibitor-based combination, 20 a non-nucleoside reverse transcriptase inhibitor-based combination, one both). At presentation, the mean CD4 count was 142 cells/µl (range 4- 636) and HIV-1 RNA viral load was undetectable in nine (30%) patients. International Prognostic Index (IPI) scores for aggressive lymphoma (based on age, LDH, stage, performance status and extranodal sites) were 0 in four patients, 1 in four patients, 2 in eight patients, 3 in seven patients and 4 in seven patients. The median overall survival (OS) was 1.2 years and 2-year OS was 50%. One patient died in remission 1.2 years after therapy of an HIV-related cause; the remaining 12 deaths were NHL- or therapy-related.
CONCLUSIONS: Treatment with CDE and HAART is associated with a median survival of over 1 year, comparing favourably with our previous regimens. The OS correlated with NHL-related factors (IPI index) rather than HIV-associated factors (CD4 count and viral load). This differs from prognostic indicators of the pre-HAART era.
PRESENTING AUTHOR: C Thirlwell
030424
O13
Copyright © 2003 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD