Rituximab plus CDE for HIV-related Non-Hodgkins Lymphoma (NHL)
Simon Collins, HIV i-Base
Spina and colleagues from the Italian Cancer Centre presented results from a phase-II study (started in June 1998) of the monoclonal antibody rituximab given with CDE therapy plus HAART in 64 HIV-positive patients with NHL. Sixty-nine percent of patients had advanced stage (III-IV) disease and 52% had B symptoms. Median baseline CD4 count was 161 cells/mm3 (range 3-691).
CDE was administered by continuous intravenous infusion for four days every four weeks (cyclophosphamide 187.5 mg/m2/day, doxorubicin 12.5 mg/m2/day and etoposide 60 mg/m2/day) and rituximab 375 mg/m2 i.v. on day one of each cycle. HAART was given concomitantly with CT.
Forty-five out of 64 patients (71%) achieved a complete remission (CR), 4/64 (6%) had a partial remission and 15 patients progressed. Seven of the CRs have since relapsed and 44/64 patients are still alive. Grade 3-4 neutropaenia, anaemia and thrombocytopaenia were observed in 78%, 36% and 25% of patients respectively. One quarter of the patients developed bacterial infections during neutropenia. The actuarial overall survival and time to treatment failure (TTF) at two years were 65% and 63% respectively.
The study concluded that the combination of rituximab and CDE treated concomitantly with HAART is safe, feasible and active and that the clearance rate (71%) and TTF at two years (63%) are comparable to those observed in high grade NHL of the general population.
Spina M, Simonelli C, Vaccher E et al. Rituximab and infusional cyclophosphamide, doxorubicin and etoposide (CDE) in combination with HAART: a safe and highly active regimen in HIV-related Non-Hodgkins Lymphoma (NHL). 9th EACS, Warsaw. 25-29 October 2003. Abstract F9/1.