Purpose To evaluate in a pilot study the safety and efficacy of liposomal doxorubicin in conjunction with cyclophosphamide and etoposide (LACE) and antiretroviral therapy (ART) in patients with AIDS-related lymphoma (ARL) and Hodgkin's disease (HD). The impact of HIV viral control on therapy and survival was also assessed.
Patients and Methods Between 1994 and 2005, 50 patients were diagnosed with ARL (n = 40) and HD (n = 10) at VMMC, of whom 15 received liposomal doxorubicin (30 mg/m2 IV d1), cyclophosphamide (700 mg/m2 IV d1), and etoposide (60 mg/m2 IV d1 and 120 mg/m2 po d2-3) q 28 days. All patients received intrathecal chemoprophylaxis, ART, and G-CSF (d 3-12).
Results The median patient CD4+ count was 181 cells/μL (range 20-853 cells/μL), and the median HIV VL was 34,011 copies/mL (range < 50-500,000 copies/mL). Eight patients (53%) had an International Prognostic Index score of 3 or 4. Six patients (40%) were ART naïve, 7 patients were viremic despite ART, and 2 had an undetectable HIV VL. Eleven patients (73%) achieved a complete response (CR), and the median overall survival was 62.6 months. At a median follow-up of 29 months, recurrence-free survival is 47%. Three patients died from relapsed/refractory ARL and 2 patients achieved CR with salvage therapy. One CR patient died from complications of pneumonia and another CR patient died from uncertain causes 5 years after treatment. Grade 3 or 4 neutropenia occurred in 33 of 78 (42%) chemotherapy cycles. Hospitalization was required after 4% of treatment cycles due to neutropenic fever.
Conclusion LACE is an effective and tolerable treatment for ARL. HIV viral control could be maintained in the majority of patients during and after completion of LACE.
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