TY - JOUR
T1 - Rituximab plus infusional cyclophosphamide, doxorubicin, and etoposide in HIV-associated non-Hodgkin lymphoma
T2 - Pooled results from 3 phase 2 trials
AU - Spina, Michele
AU - Jaeger, Ulrich
AU - Sparano, Joseph A.
AU - Talamini, Renato
AU - Simonelli, Cecilia
AU - Michieli, Mariagrazia
AU - Rossi, Giuseppe
AU - Nigra, Ezio
AU - Berretta, Massimiliano
AU - Cattaneo, Chiara
AU - Rieger, Armin C.
AU - Vaccher, Emanuela
AU - Tirelli, Umberto
PY - 2005/3/1
Y1 - 2005/3/1
N2 - Evidence suggests that infusional therapy is a more effective means for administering cytotoxic therapy than intravenous bolus therapy for lymphoma and offers greater potential for therapeutic synergy with rituximab, which has a long half-life. We pooled the results of 3 prospective phase 2 trials evaluating rituximab in combination with 96-hour infusion of cyclophosphamide (187.5-200 mg/m2 per day), doxorubicin (12.5 mg/m2 per day), and etoposide (60 mg/m2 per day) (R-CDE) plus granulocyte-colony- stimulating factor (G-CSF) in 74 patients with HIV-associated, B-cell non-Hodgkin lym phoma, of whom 56 (76%) patients received concurrent highly active antiretroviral therapy (HAART). The complete remission (CR) rate was 70% (95% confidence interval [CI], 59%-81%), and the estimated 2-year failure-free survival and overall survival rates were 59% (95% CI, 47%-71%) and 64% (95% CI, 52%-76%), respectively. Ten (14%) patients had opportunistic infections during or within 3 months of the end of R-CDE, and 17 (23%) patients developed nonopportunistic infections after that time. Six (8%) patients died because of infection; 2 (3%) of those infections were bacterial sepsis during R-CDE, and 4 (5%) were opportunistic infections that occurred between 2 and 8 months after the completion of R-CDE. R-CDE produced a 70% CR rate and a 59% 2-year failure-free survival rate in patients with HIV-associated lymphoma. Consistent with other reports, adding rituximab to cytotoxic therapy in this population may increase the risk for life-threatening infection. Further studies evaluating rituximab in combination with infusional chemotherapy are warranted, but caution is advised.
AB - Evidence suggests that infusional therapy is a more effective means for administering cytotoxic therapy than intravenous bolus therapy for lymphoma and offers greater potential for therapeutic synergy with rituximab, which has a long half-life. We pooled the results of 3 prospective phase 2 trials evaluating rituximab in combination with 96-hour infusion of cyclophosphamide (187.5-200 mg/m2 per day), doxorubicin (12.5 mg/m2 per day), and etoposide (60 mg/m2 per day) (R-CDE) plus granulocyte-colony- stimulating factor (G-CSF) in 74 patients with HIV-associated, B-cell non-Hodgkin lym phoma, of whom 56 (76%) patients received concurrent highly active antiretroviral therapy (HAART). The complete remission (CR) rate was 70% (95% confidence interval [CI], 59%-81%), and the estimated 2-year failure-free survival and overall survival rates were 59% (95% CI, 47%-71%) and 64% (95% CI, 52%-76%), respectively. Ten (14%) patients had opportunistic infections during or within 3 months of the end of R-CDE, and 17 (23%) patients developed nonopportunistic infections after that time. Six (8%) patients died because of infection; 2 (3%) of those infections were bacterial sepsis during R-CDE, and 4 (5%) were opportunistic infections that occurred between 2 and 8 months after the completion of R-CDE. R-CDE produced a 70% CR rate and a 59% 2-year failure-free survival rate in patients with HIV-associated lymphoma. Consistent with other reports, adding rituximab to cytotoxic therapy in this population may increase the risk for life-threatening infection. Further studies evaluating rituximab in combination with infusional chemotherapy are warranted, but caution is advised.
UR - http://www.scopus.com/inward/record.url?scp=20144367599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20144367599&partnerID=8YFLogxK
U2 - 10.1182/blood-2004-08-3300
DO - 10.1182/blood-2004-08-3300
M3 - Article
C2 - 15550484
AN - SCOPUS:20144367599
SN - 0006-4971
VL - 105
SP - 1891
EP - 1897
JO - Blood
JF - Blood
IS - 5
ER -