Title | Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma. |
Publication Type | Journal Article |
Year of Publication | 2010 |
Authors | Sparano JA, Lee JY, Kaplan LD, Levine AM, Ramos JCarlos, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Von Roenn J, Dezube BJ, Remick SC, Shah MH, Leichman L, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R |
Corporate Authors | AIDS Malignancy Consortium |
Journal | Blood |
Volume | 115 |
Issue | 15 |
Pagination | 3008-16 |
Date Published | 2010 Apr 15 |
ISSN | 1528-0020 |
Keywords | Adult, Antibodies, Monoclonal, Antibodies, Monoclonal, Murine-Derived, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Cyclophosphamide, Disease Progression, Disease-Free Survival, Doxorubicin, Etoposide, Female, HIV, Humans, Infusions, Intravenous, Lymphoma, B-Cell, Male, Middle Aged, Prednisone, Rituximab, Treatment Outcome, Vincristine |
Abstract | Rituximab plus intravenous bolus chemotherapy is a standard treatment for immunocompetent patients with B-cell non-Hodgkin lymphoma (NHL). Some studies have suggested that rituximab is associated with excessive toxicity in HIV-associated NHL, and that infusional chemotherapy may be more effective. We performed a randomized phase 2 trial of rituximab (375 mg/m(2)) given either concurrently before each infusional etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy cycle or sequentially (weekly for 6 weeks) after completion of all chemotherapy in HIV-associated NHL. EPOCH consisted of a 96-hour intravenous infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by intravenous bolus cyclophosphamide given every 21 days for 4 to 6 cycles. In the concurrent arm, 35 of 48 evaluable patients (73%; 95% confidence interval, 58%-85%) had a complete response. In the sequential arm, 29 of 53 evaluable patients (55%; 95% confidence interval, 41%-68%) had a complete response. The primary efficacy endpoint was met for the concurrent arm only. Toxicity was comparable in the 2 arms, although patients with a baseline CD4 count less than 50/microL had a high infectious death rate in the concurrent arm. We conclude that concurrent rituximab plus infusional EPOCH is an effective regimen for HIV-associated lymphoma. |
DOI | 10.1182/blood-2009-08-231613 |
Alternate Journal | Blood |
PubMed ID | 20023215 |
Related Faculty:
Amy Chadburn, M.D. Ethel Cesarman, M.D., Ph.D.