Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma: An Eastern Cooperative Oncology Group Trial (E1494)

Joseph A. Sparano, Sandra Lee, Michael G. Chen, Tipu Nazeer, Avi Israel Einzig, Richard F. Ambinder, David H. Henry, Jane Manalo, Tianhong Li, Jamie H. Von Roenn

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice. Patients and Methods: Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m2/d, doxorubicin 12.5 mg/m2/d, and etoposide 60 mg/m2/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group). Results: Complete response occurred in 44 patients (45%; 95% CI, 35% to 55%). Failure-free survival and overall survival (OS) at 2 years was 36% (95% CI, 26% to 46%) and 43% (95% CI, 33% to 53%), respectively. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P = .039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22% v 42%; P = .037), thrombocytopenia (31% v 52%; P = .033), and anemia (9% v27%; P = .021), and had fewer treatment-associated deaths (0% v 10%; P = .013). Conclusion: Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.

Original languageEnglish (US)
Pages (from-to)1491-1500
Number of pages10
JournalJournal of Clinical Oncology
Volume22
Issue number8
DOIs
StatePublished - 2004
Externally publishedYes

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Etoposide
Highly Active Antiretroviral Therapy
Non-Hodgkin's Lymphoma
Doxorubicin
Cyclophosphamide
HIV
Survival
Lymphoma
Didanosine
Drug Therapy
Nucleosides
Intravenous Infusions
Thrombocytopenia
Anemia

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma : An Eastern Cooperative Oncology Group Trial (E1494). / Sparano, Joseph A.; Lee, Sandra; Chen, Michael G.; Nazeer, Tipu; Einzig, Avi Israel; Ambinder, Richard F.; Henry, David H.; Manalo, Jane; Li, Tianhong; Von Roenn, Jamie H.

In: Journal of Clinical Oncology, Vol. 22, No. 8, 2004, p. 1491-1500.

Research output: Contribution to journalArticle

Sparano, Joseph A. ; Lee, Sandra ; Chen, Michael G. ; Nazeer, Tipu ; Einzig, Avi Israel ; Ambinder, Richard F. ; Henry, David H. ; Manalo, Jane ; Li, Tianhong ; Von Roenn, Jamie H. / Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma : An Eastern Cooperative Oncology Group Trial (E1494). In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 8. pp. 1491-1500.
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abstract = "Purpose: To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice. Patients and Methods: Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m2/d, doxorubicin 12.5 mg/m2/d, and etoposide 60 mg/m2/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group). Results: Complete response occurred in 44 patients (45{\%}; 95{\%} CI, 35{\%} to 55{\%}). Failure-free survival and overall survival (OS) at 2 years was 36{\%} (95{\%} CI, 26{\%} to 46{\%}) and 43{\%} (95{\%} CI, 33{\%} to 53{\%}), respectively. At the time of the analysis, 30{\%} in the pre-HAART group were alive compared with 47{\%} in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P = .039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22{\%} v 42{\%}; P = .037), thrombocytopenia (31{\%} v 52{\%}; P = .033), and anemia (9{\%} v27{\%}; P = .021), and had fewer treatment-associated deaths (0{\%} v 10{\%}; P = .013). Conclusion: Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.",
author = "Sparano, {Joseph A.} and Sandra Lee and Chen, {Michael G.} and Tipu Nazeer and Einzig, {Avi Israel} and Ambinder, {Richard F.} and Henry, {David H.} and Jane Manalo and Tianhong Li and {Von Roenn}, {Jamie H.}",
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T1 - Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma

T2 - An Eastern Cooperative Oncology Group Trial (E1494)

AU - Sparano, Joseph A.

AU - Lee, Sandra

AU - Chen, Michael G.

AU - Nazeer, Tipu

AU - Einzig, Avi Israel

AU - Ambinder, Richard F.

AU - Henry, David H.

AU - Manalo, Jane

AU - Li, Tianhong

AU - Von Roenn, Jamie H.

PY - 2004

Y1 - 2004

N2 - Purpose: To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice. Patients and Methods: Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m2/d, doxorubicin 12.5 mg/m2/d, and etoposide 60 mg/m2/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group). Results: Complete response occurred in 44 patients (45%; 95% CI, 35% to 55%). Failure-free survival and overall survival (OS) at 2 years was 36% (95% CI, 26% to 46%) and 43% (95% CI, 33% to 53%), respectively. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P = .039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22% v 42%; P = .037), thrombocytopenia (31% v 52%; P = .033), and anemia (9% v27%; P = .021), and had fewer treatment-associated deaths (0% v 10%; P = .013). Conclusion: Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.

AB - Purpose: To determine the effectiveness of an infusional chemotherapy regimen in patients with HIV-associated lymphoma treated before and after the use of highly active antiretroviral therapy (HAART) in routine clinical practice. Patients and Methods: Ninety-eight assessable patients with HIV-associated intermediate- or high-grade non-Hodgkin's lymphoma received cyclophosphamide 200 mg/m2/d, doxorubicin 12.5 mg/m2/d, and etoposide 60 mg/m2/d (CDE) given by continuous intravenous infusion for 4 days (96 hours) every 4 weeks plus filgrastim. Concurrent antiretroviral treatment consisted of the nucleoside analog didanosine in the first 43 patients enrolled before December 1996 (pre-HAART group), or HAART in the remaining 55 patients enrolled after that time (HAART group). Results: Complete response occurred in 44 patients (45%; 95% CI, 35% to 55%). Failure-free survival and overall survival (OS) at 2 years was 36% (95% CI, 26% to 46%) and 43% (95% CI, 33% to 53%), respectively. At the time of the analysis, 30% in the pre-HAART group were alive compared with 47% in the HAART group; when adjusted for varying length of follow-up, patients in the HAART group had improved OS (P = .039). Patients in the HAART group experienced less grade 4 nonhematologic toxicity (22% v 42%; P = .037), thrombocytopenia (31% v 52%; P = .033), and anemia (9% v27%; P = .021), and had fewer treatment-associated deaths (0% v 10%; P = .013). Conclusion: Infusional CDE is an effective and potentially curative regimen for patients with HIV-associated lymphoma. Patients treated in the HAART era have less chemotherapy-associated toxicity and improved survival.

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