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 µg/d for patients < 70 kg & 480 µg/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.
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