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Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma
Author(s) -
Wang Eunice S.,
Straus David J.,
TeruyaFeldstein Julie,
Qin Jing,
Portlock Carol,
Moskowitz Craig,
Goy Andre,
Hedrick Eric,
Zelenetz Andrew D.,
Noy Ariela
Publication year - 2003
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.11628
Subject(s) - medicine , etoposide , ifosfamide , cytarabine , cyclophosphamide , doxorubicin , chemotherapy , methotrexate , lymphoma , virology , human immunodeficiency virus (hiv) , oncology
Abstract BACKGROUND In the era of highly active antiretroviral therapy (HAART), standard‐dose chemotherapy for human immunodeficiency virus (HIV)‐associated diffuse large B‐cell lymphoma is becoming the standard of care. In contrast, the safety and efficacy of intensive regimens have not been established for Burkitt lymphoma (BL), a highly aggressive lymphoma for which moderate‐dose chemotherapy is substandard in the HIV‐negative population. METHODS To evaluate the feasibility of intensive chemotherapy in HIV‐associated BL, the authors retrospectively reviewed 14 HIV‐positive adults with BL treated at their center between 1988 and 2000. Eight patients were treated between 1996 and 2000 with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC), one of the currently preferred intensive‐dose chemotherapy regimens for BL. Six received other chemotherapy. Outcomes were compared with those of 24 HIV‐negative adult patients with BL who had similar patient characteristics and were treated concomitantly (13 with CODOX‐M/IVAC; 11 with other regimens). RESULTS Of the 14 HIV‐positive patients, 63% had a complete response after CODOX‐M/IVAC treatment, compared with 67% of patients receiving other chemotherapy. The 2‐year event‐free survival (EFS) rates were 60% and 60% after CODOX‐M/IVAC or other regimens, respectively. Similar outcomes were seen despite the fact that 88% of CODOX‐M/IVAC‐treated HIV‐positive patients had Stage IV disease, compared with one‐third of HIV‐positive patients treated with other chemotherapy. HIV status did not adversely affect long‐term EFS independent of the treatment regimen ( P = 0.88). When EFS was evaluated according to chemotherapy regimen independent of HIV status, CODOX‐M/IVAC was found to be associated with improved EFS ( P = 0.05) in all patients, and particularly those at high risk. HIV‐positive patients treated with CODOX‐M/IVAC tolerated chemotherapy well with similar rates of myelosuppression and infectious complications as HIV‐negative patients. CONCLUSIONS The current nonrandomized retrospective study suggested that intensive chemotherapy with CODOX‐M/IVAC is feasible and well tolerated in HIV‐positive adults with BL. In the post‐HAART era, intensive chemotherapy such as CODOX‐M/IVAC may be appropriate in all adult patients with BL, and especially those with poor prognostic factors, regardless of HIV status. Cancer 2003;98:1196–205. © 2003 American Cancer Society. DOI 10.1002/cncr.11628