Low-dose compared with standard-dose m-BACOD chemotherapy for non- Hodgkin's lymphoma associated with human immunodeficiency virus infection

Lawrence D. Kaplan, David J. Straus, Marcia A. Testa, Jamie Von Roenn, Bruce J. Dezube, Timothy P. Cooley, Brian Herndier, Donald W Northfelt, Jenny Huang, Anil Tulpule, Alexandra M. Levine

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Abstract

Background: Reduced doses of cytotoxic chemotherapy or standard-dose therapy plus a myeloid colony-stimulating factor decreases hematologic toxicity and its complications in patients with non-Hodgkin's lymphoma associated with infection with the human immunodeficiency virus (HIV). However, the effect of reducing the doses of cytotoxic chemotherapeutic agents on clinical outcome is not known. Methods: We randomly assigned 198 HIV-seropositive patients with previously untreated, aggressive non-Hodgkin's lymphoma to receive standard-dose therapy with methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) along with granulocyte-macrophage colony-stimulating factor (GM-CSF; n=94) or reduced-dose m-BACOD with GM-CSF administered only as indicated (n = 98). Result: A complete response was achieved in 39 of the 94 assessable patients assigned to low-dose therapy (41 percent) and in 42 of the 81 assessable patients assigned to standard-dose therapy (52 percent, P=0.56). There were no significant differences in overall or disease-free survival; median survival times were 35 weeks for patients receiving low-dose therapy and 31 weeks for these receiving standard-dose therapy (risk ratio for death in the standard-dose group, 1.17; 95 percent confidence interval, 0.84 to 1.63; P=0.25). Toxic affects of chemotherapy rated grade 3 or higher occurred in 66 of 94 patients assigned to standard-dose therapy (70 percent) and 50 of 98 patients assigned to low-dose treatment (51 percent, P=0.008). Hematologic toxicity accounted for the difference. Conclusions: As compared with treatment with standard doses of cytotoxic chemotherapy (m-BACOD), reduced doses caused significantly fewer hematologic toxic effects yet had similar efficacy in patients with HIV-related lymphoma. Dose-modified chemotherapy should be considered for most HIV-infected patients with lymphoma.

Original languageEnglish (US)
Pages (from-to)1641-1648
Number of pages8
JournalNew England Journal of Medicine
Volume336
Issue number23
DOIs
StatePublished - 1997
Externally publishedYes

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ASJC Scopus subject areas

  • Medicine(all)

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Kaplan, L. D., Straus, D. J., Testa, M. A., Von Roenn, J., Dezube, B. J., Cooley, T. P., Herndier, B., Northfelt, D. W., Huang, J., Tulpule, A., & Levine, A. M. (1997). Low-dose compared with standard-dose m-BACOD chemotherapy for non- Hodgkin's lymphoma associated with human immunodeficiency virus infection. New England Journal of Medicine, 336(23), 1641-1648. https://doi.org/10.1056/NEJM199706053362304