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15th Annual Conference of the British HIV Association1-3 April 2009, Liverpool, UK |
EXCELLENT IMMUNOLOGICAL RECOVERY FOLLOWING THE INTENSIVE CHEMOTHERAPY CODOX-M/IVAC, AN EFFECTIVE THERAPY FOR HIV-ASSOCIATED BURKITT’S LYMPHOMA
HIV Med 2009 Apr 1-3 (Suppl 1);15:9 (abstract no. O15)
J Wilson1, S Montoto2, K Shaw3, C Orkin2, M Johnson1, M Nelson3, M Bower3 and K Cwynarski1
1Royal Free Hospital, London, UK, 2St Barthelomew’s Hospital, London, UK, 3 Chelsea and Westminster Hospital, London, UK
BACKGROUND: There has been considerable improvement in the outcome of non-HIV adults with Burkitt’s lymphoma (BL) with the advent of intensive chemotherapy schedules. There has been reluctance for their use in HIV-BL due to concerns about increased opportunistic infections and other toxicity. A few studies have reported promising results for patients with HIV-BL treated with intensive chemotherapies. However immunological recovery following these regimens has not been published.
METHODS: Thirty consecutive patients (23 male; median age: 38 years) from 3 UK centres treated with CODOX-M-IVAC and highly active antiretroviral therapy (HAART) were included. CODOX-M/IVAC consisted of four alternating cycles of CODOX-M (cyclophosphamide, doxorubicin, vincristine, methotrexate) and IVAC (etoposide, ifosfamide, cytarabine) (high-risk) or 3 cycles of CODOX-M (low-risk). Two or more adverse factors (stage III-IV, ECOG>2, extra-nodal sites>2, high LDH) defined high-risk disease.
RESULTS: The median CD4 cell count at diagnosis of HIV-BL was 167 (range: 4–848), plasma HIV viral load (VL) was undetectable in 5/28 patients (18%). Twenty-two patients (72%) had high-risk disease. Grade 3–4 non-haematological toxicity was as follows: infection (66)% of the cycles; mucositis (12%) and diarrhoea (12%). Nine patients died during treatment (disease progression: 3, toxicity: 5, CNS lesion not biopsed: 1). Response rate was 70% (complete response (CR)/CR uncertain: 17, partial response (PR): 4). After a median follow-up of 22 months (range: 9–67), 17 patients remain alive without disease progression. The 3-year overall survival (OS) and event-free survival (EFS) were 52% and 75%, respectively. VL was undetectable in 88% and CD4>200 mL in 58% of assessed patients 6 months after completing chemotherapy, and at 12 months in 87% and 80%, respectively.
2009-04-01
O15
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