Myc matters in HIV-associated lymphoma

In this issue of Blood, Ramos et al present the results of a randomized phase 2 trial that tested the addition of the oral histone deacetylase (HDAC) inhibitor vorinostat to standard rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH) for patients with HIV-associated diffuse large B-cell lymphoma (DLBCL). Although it was solidly based on preclinical data supporting the concept that an HDAC inhibitor would add efficacy in tumors that often harbor Epstein-Barr virus in the setting of HIV infection, it did not translate into a better result in the clinic, at least with this HDAC inhibitor combined with the R-EPOCH backbone. The complete remission (CR) rates with R-EPOCH (74%) vs R-EPOCH with vorinostat (68%) (P 5.72) and the overall survival (OS) and event-free survival (EFS) rates were similar between arms.¹