Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma

Joseph A. Sparano, Jeannette Y. Lee, Lawrence D. Kaplan, Alexandra M. Levine, Juan Carlos Ramos, Richard F. Ambinder, William Wachsman, David Aboulafia, Ariela Noy, David H. Henry, Jamie Von Roenn, Bruce J. Dezube, Scot C. Remick, Manisha H. Shah, Lawrence Leichman, Lee Ratner, Ethel Cesarman, Amy Chadburn, Ronald Mitsuyasu

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152 Scopus citations

Abstract

Rituximab plus intravenous bolus chemotherapy is a standard treatment for immunocompetent patients with B-cell non-Hodgkin lymphoma (NHL). Some studies have suggested that rituximab is associated with excessive toxicity in HIV-associated NHL, and that infusional chemotherapy may be more effective. We performed a randomized phase 2 trial of rituximab (375 mg/m2) given either concurrently before each infusional etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy cycle or sequentially (weekly for 6 weeks) after completion of all chemotherapy in HIV-associated NHL. EPOCH consisted of a 96-hour intravenous infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by intravenous bolus cyclophosphamide given every 21 days for 4 to 6 cycles. In the concurrent arm, 35 of 48 evaluable patients (73%; 95% confidence interval, 58%-85%) had a complete response. In the sequential arm, 29 of 53 evaluable patients (55%; 95% confidence interval, 41%-68%) had a complete response. The primary efficacy endpoint was met for the concurrent arm only. Toxicity was comparable in the 2 arms, although patients with a baseline CD4 count less than 50/μL had a high infectious death rate in the concurrent arm.We conclude that concurrent rituximab plus infusional EPOCH is an effective regimen for HIV-associated lymphoma. This study is registered at http://clinicaltrials.gov as NCT00049036.

Original languageEnglish (US)
Pages (from-to)3008-3016
Number of pages9
JournalBlood
Volume115
Issue number15
DOIs
StatePublished - Apr 15 2010

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Sparano, J. A., Lee, J. Y., Kaplan, L. D., Levine, A. M., Ramos, J. C., Ambinder, R. F., Wachsman, W., Aboulafia, D., Noy, A., Henry, D. H., Von Roenn, J., Dezube, B. J., Remick, S. C., Shah, M. H., Leichman, L., Ratner, L., Cesarman, E., Chadburn, A., & Mitsuyasu, R. (2010). Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma. Blood, 115(15), 3008-3016. https://doi.org/10.1182/blood-2009-08-231613