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[Blood] Rituximab plus concurrent infusional EPOCH chemotherapy is highly effect
작성자
홍기종
작성일
2009-12-22
조회
1097

Blood. 2009 Dec 18. [Epub ahead of print]

Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated, B-cell non-Hodgkin's lymphoma.

Sparano JA, Lee JY, Kaplan LD, Levine AM, Ramos JC, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Von Roenn J, Dezube BJ, Remick SC, Shah MH, Leichman L, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R.

Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY;

 

Rituximab plus intravenous (IV) bolus chemotherapy is a standard treatment for immunocompetent patients with B-cell non-Hodgkin's lymphoma (NHL). Some studies have suggested that rituximab is associated with excessive toxicity in HIV-associated NHL, and that infusional chemotherapy may be more effective. We performed a randomized phase II trial of rituximab (375 mg/m(2)) given either concurrently prior to each infusional EPOCH chemotherapy cycle, or sequentially (weekly for 6 weeks) following completion of all chemotherapy in patients with HIV-associated NHL. EPOCH consisted of a 96-hour IV infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by IV bolus cyclophosphamide given every 21 days for up to 4-6 cycles. In the concurrent arm, 35 of 48 evaluable patients (73%; 95% confidence intervals [CI] 58%, 85%) had a CR. In the sequential arm, 29 of 53 evaluable patients (55%; 95% CI 41%, 68%) had a CR. The prespecified primary efficacy endpoint was met for the concurrent arm only. Toxicity was comparable in the two arms, although patients with a baseline CD4 count < 50/uL had a high infectious death rate in the concurrent arm. We conclude that concurrent rituximab plus infusional EPOCH is an effective regimen for HIV-associated lymphoma which merits further evaluation. This study is registered at http://clinicaltrials.gov as NCT00049036.