Background and Objectives. Intensive chemotherapy (CHT) in AIDS-related non
-Hodgkin's lymphoma (AIDS-NHL patients) is a vexing problem. Our purpose wa
s to evaluate the feasibility of a high dose idarubicin (HD-IDA)-based regi
men in diffuse large cell (DLC) AIDS-NHL patients.
Design and Methods. Fourteen stage I-IV untreated DLC AIDS-NHL patients wit
h a performance status <3 and no prior AIDS-related diseases received CIOD:
cyclophosphamide, HD-IDA (25 mg/m(2) in 8 patients, 20 mg/m(2) in 6 patien
ts) vincristine and dexamethasone plus granulocyte colony-stimulating facto
r (G-CSF) and prophylaxis against infections. The outcomes measured were: r
ate of response, disease-free survival (DFS), overall survival (OS) and the
impact of chemotherapy on immunologic and virological parameters.
Results. Complete response was achieved in 13/14 cases (response rate: 93%)
. The median time of response and survival was 33 (range 5-79) and 35.5 (ra
nge 6-84) months, respectively. At 60 months the DFS and OS were 71% and 44
%, respectively. CIOD with idarubicin 20 mg/m(2) was better tolerated than
that with 25 mg/m(2) and was administered with a higher mean average-relati
ve-dose-intensity (95.38 +/-7% vs 83.35 +/- 15.59%, p=0.0001). Opportunisti
c infections were more frequent in patients with a baseline CD4 < 100 than
those with > 100 cells/muL (4/5 vs 1/9: p=0.0229). After 3 CIOD courses the
mean CD4 cells/muL was significantly lower (p=0.001) and the mean HIV.1 RN
A load was significantly higher (p=0.045) than at baseline.
Interpretation and Conclusions. The proposed chemotherapeutic regimen for A
IDS-related non-Hodgkin's lymphoma is feasible in an outpatient setting in
selected patients with relatively well-preserved immune function. (C) 2001,
Ferrata Storti Foundation.