Intensive chemotherapy with cyclophosphamide, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) for human immunodeficiency virus-associated Burkitt lymphoma Journal Article


Authors: Wang, E. S.; Straus, D. J.; Teruya-Feldstein, J.; Qin, J.; Portlock, C.; Moskowitz, C.; Goy, A.; Hedrick, E.; Zelenetz, A. D.; Noy, A.
Article Title: Intensive chemotherapy with cyclophosphamide, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) for human immunodeficiency virus-associated Burkitt lymphoma
Abstract: BACKGROUND. In the era of highly active antiretroviral therapy (HAART), standarddose chemotherapy for human immunodeficiency virus (HIV)-associated diffuse large B-cell lymphoma is becoming the standard of care. In contrast, the safety and efficacy of intensive regimens have not been established for Burkitt lymphoma (BL), a highly aggressive lymphoma for which moderate-dose chemotherapy is substandard in the HIV-negative population. METHODS. To evaluate the feasibility of intensive chemotherapy in HIV-associated BL, the authors retrospectively reviewed 14 HIV-positive adults with BL treated at their center between 1988 and 2000. Eight patients were treated between 1996 and 2000 with cyclophosphamide, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC), one of the currently preferred intensive-dose chemotherapy regimens for BL. Six received other chemotherapy. Outcomes were compared with those of 24 HIV-negative adult patients with BL who had similar patient characteristics and were treated concomitantly (13 with CODOX-M/IVAC; 11 with other regimens). RESULTS. Of the 14 HIV-positive patients, 63% had a complete response after CODOX-M/IVAC treatment, compared with 67% of patients receiving other chemotherapy. The 2-year event-free survival (EFS) rates were 60% and 60% after CODOX-M/IVAC or other regimens, respectively. Similar outcomes were seen despite the fact that 88% of CODOX-M/IVAC-treated HIV-positive patients had Stage IV disease, compared with one-third of HIV-positive patients treated with other chemotherapy. HIV status did not adversely affect long-term EFS independent of the treatment regimen (P = 0.88). When EFS was evaluated according to chemotherapy regimen independent of HIV status, CODOX-M/IVAC was found to be associated with improved EFS (P = 0.05) in all patients, and particularly those at high risk. HIV-positive patients treated with CODOX-M/IVAC tolerated chemotherapy well with similar rates of myelosuppression and infectious complications as HIV-negative patients. CONCLUSIONS. The current nonrandomized retrospective study suggested that intensive chemotherapy with CODOX-M/IVAC is feasible and well tolerated in HIV-positive adults with BL. In the post-HAART era, intensive chemotherapy such as CODOX-M/IVAC may be appropriate in all adult patients with BL, and especially those with poor prognostic factors, regardless of HIV status. © 2003 American Cancer Society.
Keywords: adult; cancer survival; clinical article; aged; disease-free survival; middle aged; retrospective studies; drug tolerability; neutropenia; doxorubicin; dose response; drug efficacy; drug safety; cytarabine; methotrexate; human immunodeficiency virus infection; disease association; nephrotoxicity; bone marrow suppression; etoposide; gastrointestinal symptom; mucosa inflammation; antineoplastic combined chemotherapy protocols; peripheral neuropathy; cyclophosphamide; pneumocystis pneumonia; retrospective study; ifosfamide; febrile neutropenia; tumor lysis syndrome; cancer invasion; drug fatality; evaluation; outcomes research; sepsis; human immunodeficiency virus; pancytopenia; highly active antiretroviral therapy; high risk population; proteinase inhibitor; lymphoma, aids-related; burkitt lymphoma; infection complication; non-hodgkin lymphoma; zidovudine; lamivudine; intensive chemotherapy; indinavir; stavudine; nelfinavir; nevirapine; humans; prognosis; human; male; female; priority journal; article
Journal Title: Cancer
Volume: 98
Issue: 6
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2003-09-15
Start Page: 1196
End Page: 1205
Language: English
DOI: 10.1002/cncr.11628
PUBMED: 12973843
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Carol Portlock
    181 Portlock
  2. Craig Moskowitz
    375 Moskowitz
  3. Ariela Noy
    208 Noy
  4. Julie T Feldstein
    288 Feldstein
  5. Eric E Hedrick
    16 Hedrick
  6. Eunice S Wang
    13 Wang
  7. Jing Qin
    86 Qin
  8. Andrew D Zelenetz
    556 Zelenetz
  9. David J Straus
    213 Straus
  10. Andre Goy
    28 Goy