Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related Non-Hodgkin's lymphoma: A highly active regimen

Joseph A. Sparano, Peter H. Wiernik, Margery Strack, Andrea Leaf, Norwin Becker, Edward S. Valentine

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/μL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21 %), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.

Original languageEnglish (US)
Pages (from-to)2810-2815
Number of pages6
JournalBlood
Volume81
Issue number10
StatePublished - May 15 1993

Fingerprint

Human T-lymphotropic virus 1
T-cells
Etoposide
Viruses
Non-Hodgkin's Lymphoma
Doxorubicin
Cyclophosphamide
HIV
L-Lactate Dehydrogenase
Virus Diseases
Acquired Immunodeficiency Syndrome
Candidemia
Karnofsky Performance Status
Agranulocytosis
Aspergillosis
Opportunistic Infections
CD4 Lymphocyte Count
Bacteremia
Intravenous Infusions

ASJC Scopus subject areas

  • Hematology

Cite this

Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related Non-Hodgkin's lymphoma : A highly active regimen. / Sparano, Joseph A.; Wiernik, Peter H.; Strack, Margery; Leaf, Andrea; Becker, Norwin; Valentine, Edward S.

In: Blood, Vol. 81, No. 10, 15.05.1993, p. 2810-2815.

Research output: Contribution to journalArticle

Sparano, Joseph A. ; Wiernik, Peter H. ; Strack, Margery ; Leaf, Andrea ; Becker, Norwin ; Valentine, Edward S. / Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related Non-Hodgkin's lymphoma : A highly active regimen. In: Blood. 1993 ; Vol. 81, No. 10. pp. 2810-2815.
@article{08315dd674f4417faadb6989f7ea331d,
title = "Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related Non-Hodgkin's lymphoma: A highly active regimen",
abstract = "Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70{\%} (six patients), a CD4 count less than 100/μL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71{\%}; 95{\%} confidence interval, 48{\%} to 95{\%}) and partial response (PR) occurred in three patients (21 {\%}), yielding an overall objective response rate of approximately 93{\%}. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19{\%} of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36{\%}), bacteremia occurred in three patients (21{\%}), and candidemia occurred in one patient (7{\%}). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.",
author = "Sparano, {Joseph A.} and Wiernik, {Peter H.} and Margery Strack and Andrea Leaf and Norwin Becker and Valentine, {Edward S.}",
year = "1993",
month = "5",
day = "15",
language = "English (US)",
volume = "81",
pages = "2810--2815",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "10",

}

TY - JOUR

T1 - Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related Non-Hodgkin's lymphoma

T2 - A highly active regimen

AU - Sparano, Joseph A.

AU - Wiernik, Peter H.

AU - Strack, Margery

AU - Leaf, Andrea

AU - Becker, Norwin

AU - Valentine, Edward S.

PY - 1993/5/15

Y1 - 1993/5/15

N2 - Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/μL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21 %), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.

AB - Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/μL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21 %), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.

UR - http://www.scopus.com/inward/record.url?scp=0027310171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027310171&partnerID=8YFLogxK

M3 - Article

C2 - 8490187

AN - SCOPUS:0027310171

VL - 81

SP - 2810

EP - 2815

JO - Blood

JF - Blood

SN - 0006-4971

IS - 10

ER -