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Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
Lymphoma, AIDS

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Should we treat or not???
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AIDS Related Lymphoma
1. CHOP (vs mCHOP)
2. mBACOD

CHOP
FULL DOSE (CHOP) vs MODIFIED DOSE(mCHOP)
HIV-associated NHL of intermediate or high grade
REF: JCO 19: 2171, 2001

CYCLOPHOSPHAMIDE 750 mg/m2,
DOXORUBICIN 50 mg/m2,
VINCRISTINE 1.4 mg/m2 (maximum dose, 2.0 mg),
All given IV on day 1 of each cycle, together with PREDNISONE on days 1-5, & G-CSF 300 g/d for patients < 70 kg & 480 g/d for patients > 70 kg with all cycles.

All patients received Pneumocystis carinii pneumonia (PCP) prophylaxis, & all clinically indicated antibiotics except ketoconazole & rifampin were permitted. All patients also received stavudine, lamivudine, & indinavir.

Dose modifications or delays were instituted if ANC was less than 1,000/mm3, platelets were less than 75,000/mm3, bilirubin was more than 1.25 times the upper limits of normal (ULN), ALT or AST were more than 5 times ULN, or any other nonhematologic grade 3 or 4 toxicity.


mCHOP arm CR=30% PR=30% Relapse=33% (of CR pts)
Full-dose CHOP CR=48% PR=9% Relapse=9% (of CR pts)
____________________________________________________________

mBACOD
REF: NEJM 336:1641, 1997

METHOTREXATE 200 mg/m2 DAY 15
BLEOMYCIN 4 U/m2 DAY 1
DOXORUBICIN 45 mg/m2 DAY 1
CYCLOPHOSPHAMIDE 600 mg/m2 DAY 1
VINCRISTINE 1.4 mg/m2
DEXAMETHASONE 6 mg/m2 DAYS 1-5
GMCSF 5 ug/kg on DAYS 4-13

Modified-mBACOD (low-dose)
REF: NEJM 336:1641, 1997

METHOTREXATE 200 mg/m2 DAY 15
BLEOMYCIN 4 U/m2 DAY 1
DOXORUBICIN 25 mg/m2 DAY 1
CYCLOPHOSPHAMIDE 300 mg/m2 DAY 1
VINCRISTINE 1.4 mg/m2
DEXAMETHASONE 3 mg/m2 DAYS 1-5
GMCSF 5 ug/kg on DAYS 4-13


Meningeal Lymphoma prophylaxis:
CYTARABINE 50 mg IT DAYS 1, 8, 15, 22

CR=41% in mBACOD group, 52 percent in modified mBACOD (P=0.56). No significant differences in OS of DFS. Median survival times were 35 weeks (low-dose therapy) & 31 weeks (standard-dose therapy) Toxic effects of chemotherapy rated grade 3 or higher occurred in 70% (standard dose) & 51% (modified dose)(P = 0.008). Hematologic toxicity accounted for the difference.

Proportion of (A) responders & (B) complete responders remaining free of disease during follow-up. (from JCO 19: 2171, 2001)

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Cautions:
AZT not to be used (hematopietic toxicity).