Simultaneous HIV therapy and chemotherapy for lymphoma effective and safe

The simultaneous use of potent anti-HIV therapy and chemotherapy can mean that HIV-positive patients with non-Hodgkin’s lymphoma have survival comparable to that of HIV-negative individuals treated with chemotherapy, according to a German study published in the April 1^st edition of Cancer (now online).

HIV-positive individuals who had not experienced severe immune damage experienced the most benefit from concomitant antiretroviral therapy and chemotherapy, but the investigators noted that 12% of patients with severe immune suppression who received combined HIV therapy and chemotherapy were alive three years after completing their anti-cancer treatment.

Since the introduction of effective anti-HIV therapy, there has been a dramatic fall in the incidence of lymphoma affecting the central nervous system. Antiviral therapy has also improved the prognosis of patients diagnosed with AIDS-related lymphoma, but because HIV-positive individuals are less likely to die of other opportunistic infections, the proportion of illness and death attributable to non-Hodgkin’s lymphoma has increased in recent years.

Even though it is known that the use of anti-HIV therapy can lead to a significant improvement in the health and life expectancy of HIV-positive individuals, concerns that it might interact with anti-cancer drugs mean that physicians either delay initiating antiretroviral treatment until anti-cancer therapy has been completed, or interrupt HIV treatment for the duration of chemotherapy.

German doctors wished to assess the safety and efficacy of using combined chemotherapy consisting of cyclophosamide, doxorubicin, vincristine and prednisone at the same time as potent anti-HIV therapy in individuals with non-Hodgkin’s lymphoma.

A total of 72 individuals were recruited to the study between 1997 and 2001. On the basis of the degree of immune damage and HIV-related illness which they had experienced, patients were categorised as being either ‘standard risk’ or ‘high risk.’ The median CD4 cell count prior to the initiation of chemotherapy amongst standard risk patients was 230 cells/mm³ but only 34 cells/mm³ amongst high-risk patients.

Both groups of patients received six cycles of chemotherapy as out-patients. Assessment was conducted after the second, fourth and six cycles and then at bimonthly intervals. Individuals were defined as experiencing complete remission of their cancer if there was a complete disappearance of all signs of lymphoma for at least four weeks. Partial remission was defined as a 50% reduction in the size of the malignant lesion.

Overall follow-up was 26 months. A total of 79% of standard risk patients achieved complete remission as did 29% of high-risk individuals. After three years, 60% of standard risk patients were still alive and 33% were alive after five years - such survival rates are similar to those seen in HIV-negative patients with non-Hodgkin’s lymphoma.

Amongst high-risk patients, the median duration of survival was seven months, but the investigators noted that 12% were still alive three years after completing their last cycle of chemotherapy.

A CD4 cell count below 100 cells/mm³ (p

CD4 cell counts assessed four weeks after the completion of the final cycle of chemotherapy did not differ significantly from those at baseline.

The toxicity of chemotherapy was assessed as “moderate” by the investigators. Moderate-to-severe leukopenia occurred in 100 of the 249 (40%) chemotherapy cycles provided to the standard risk patients and in 70 of the 129 (69%) of the cycles used to treat high-risk patients.

Simultaneous use of potent antiretroviral and chemotherapy for AIDS-related lymphoma is effective and safe, the investigators conclude, and should be “first line therapy for patients with AIDS-related lymphoma.”