Mitoguazone (MGBG) with radiation therapy in AIDS-related primary CNS-lymphoma.
Int Conf AIDS 1996 Jul 7-12; 11:222 (abstract no. Th.B.184) Levine A, Tulpule A, Espina BM, Von Hoff D, Tessman D; USC Norris Cancer Hospital, Los Angeles, CA, USA. Fax: (213) 764-0060.
Prognosis for patients with AIDS-related primary central nervous system (CNS) lymphoma is very poor, with median survival of 2-3 months, despite radiation. Mitoguazone dihydrochloride (MGBG) at a dose of 600mg/m2 given intravenously on day 1, 8 and then every 2 weeks has shown activity in patients with relapsed or refractory, systemic AIDS-related lymphoma. MGBG has shown good penetration into the CSF, and has minimal bone marrow toxicity. We studied MGBG as outlined above combined with radiation therapy starting after the third dose of MGBG. Thus far, 12 male and 2 female patients have been accrued with a median age of 42 yrs (range 19-47). Pathology was as follows: immunoblastic in 5; small non-cleaved in 4; diffuse large cell in 2; and high grade unclassified in 1. Two patients could not be biopsied. The median entry CD4 lymphocyte count was 8 (range 0-255). 9 had a prior AIDS-defining opportunistic infection. A median of 2+ doses (range 2-14) of MGBG have been administered thus far. 8 patients are evaluable for response; the remaining 6 are too early for response. 6 patients completed the prescribed radiation. Toxicity to MGBG was mild consisting of facial flushing in all. Hematologic toxicity included plt less than 75K in 2 and Hgb less than 8.0 in 2; there were no incidences of neutropenia less than 750/mm3. Four patients showed tumor shrinkage after MGBG induction therapy. After completion of radiation, two patients achieved partial remissions; two additional patients achieved partial remission after continued MGBG therapy post radiation. All responses were persistent, with continued improvement with therapy. The survival ranges from 0.9 to 11.7 months; 3 patients have survived over 6 mo (7+, 9.2, 11.7). We conclude that MGBG in combination with radiation therapy is a very promising treatment for these poor prognosis patients, associated with prolongation in survival and improved quality of life.
Keywords: AEGIS, Lymphoma, AIDS-Related, Mitoguazone, Lymphoma, Acquired Immunodeficiency Syndrome, Radiotherapy Dosage, Antineoplastic Agents, Neutropenia, Opportunistic Infections, CD4 Lymphocyte Count, Antibiotics, Anthracycline, Female, Male, Human, radiotherapy, ICA11
