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Rituximab
Added to Sandard Chemotherapy Is Effective for HIV-related Non Hodgkin’s
Lymphoma
Addition
of rituximab to an infusion of cyclophosphamide, doxorubicin and
etoposide (CDE) shows enhanced action against HIV-associated
B-cell non-Hodgkin's lymphoma (NHL), according to European
and US investigators.
"Non-Hodgkin's
lymphoma in patients with HIV infection can be effectively treated
with rituximab and infusional chemotherapy with results similar
to those of the general population," senior author Dr. Umberto
Tirelli told Reuters Health. "This combination seems an improvement
in comparison with previous approaches in this setting."
In
the March 1st issue of Blood, Dr. Tirelli of the National
Cancer Institute, Aviano, Italy and colleagues examined pooled results
from three phase II trials of rituximab in combination with 96-hour
infusions of CDE along with granulocyte-colony stimulating factor
[GCSF}.
A
total of 74 patients were involved, of whom 56 (76%) were receiving
concurrent highly active antiretroviral therapy (HAART).
The
complete remission rate was 70%, the estimated 2-year failure-free
survival rate was 59% and the estimated overall 2- year survival
rate was 64%.
Serious
infections were seen in 47% of patients and of these, 14% were opportunistic.
Mortality due to infection
was 8%.
Nevertheless,
concluded Dr. Tirelli, the high response rate was "very satisfactory"
and would not have been achievable in the pre-HAART era.
In
an accompanying editorial Dr. David J. Strauss of Memorial Sloan-Kettering
Cancer Center, New York, agrees that improvements in immune and
bone marrow function with HAART have made more aggressive lymphoma
treatment possible.
However,
he observes that at present, outside of clinical trials, "it
is probably safest to avoid use of rituximab with chemotherapy for
HIV-associated lymphoma."
04/18/05
Blood
2005;105:1842,1891-1897.
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