Pegylated liposomal doxorubicin, rituximab, cyclophosphamide, vincristine, and prednisone in AIDS-related lymphoma: AIDS malignancy consortium study 047

Alexandra M. Levine, Ariela Noy, Jeannette Y. Lee, Wayne Tam, Juan Carlos Ramos, David H. Henry, Samir Parekh, Erin G. Reid, Ronald Mitsuyasu, Timothy Cooley, Bruce J. Dezube, Lee Ratner, Ethel Cesarman, Anil Tulpule

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19 Scopus citations

Abstract

Purpose: Infusional chemotherapy is efficacious in patients with AIDS-related lymphoma, but it may be difficult to administer. We studied standard agents with rituximab plus pegylated liposomal doxorubicin (DR-COP) in an attempt to provide a more practical approach to therapy while ascertaining rates of response, potential infectious complications, and prognostic role of biologic markers. Patients and Methods: We conducted a prospective, multi-institutional phase II trial, employing (day 1) pegylated liposomal doxorubicin 40 mg/m2, rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2 (not > 2 mg), and prednisone 100 mg orally on days 1 through 5, with concomitant antiretroviral therapy. Results: In 40 evaluable patients, median CD4 cells was 114/μL (range, 5 to 1,026/μL), and median HIV-1 viral load (VL) was 25,000 copies/mL. High or intermediate/high age-adjusted International Prognostic Index was present in 28%. Overall response was 67.5%, with complete remission in 47.5% (95% CI, 31.5 to 63.9). Of 19 complete responders, 84% had extranodal disease, 47% had CD4 < 100/μL, and 47% had VL > 50,000 copies/mL; one relapsed. With 25.5-month median follow-up, 62% (95% CI, 44 to 75) of patients remain alive. Sixteen patients (40%) experienced 22 infections, with grade 4 in only two (5%). No patient died as a result of infection during treatment; one had opportunistic infection. Conclusion: Profound immunodeficiency and high HIV-1 viral load do not preclude attainment of complete response after DR-COP with highly active antiretroviral therapy. The regimen is tolerable, and use of rituximab was not associated with death as a result of infection during treatment. This approach may be useful in patients in whom the more intensive infusional regimens are impractical.

Original languageEnglish (US)
Pages (from-to)58-64
Number of pages7
JournalJournal of Clinical Oncology
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Levine, A. M., Noy, A., Lee, J. Y., Tam, W., Ramos, J. C., Henry, D. H., Parekh, S., Reid, E. G., Mitsuyasu, R., Cooley, T., Dezube, B. J., Ratner, L., Cesarman, E., & Tulpule, A. (2013). Pegylated liposomal doxorubicin, rituximab, cyclophosphamide, vincristine, and prednisone in AIDS-related lymphoma: AIDS malignancy consortium study 047. Journal of Clinical Oncology, 31(1), 58-64. https://doi.org/10.1200/JCO.2012.42.4648