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High-Dose Cytosine-Arabinoside and Cisplatin Regimens as Salvage Therapy for Refractory or Relapsed AIDS-Related Non-Hodgkin's Lymphoma

Bi Jia; Espina, Byron M.; Tulpule, Anil; Boswell, William; Levine, Alexandra M.
JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2001
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No effective salvage regimen has been defined for patients with AIDS-related non-Hodgkin's lymphoma (AIDS-NHL) who do not respond to first-line chemotherapy that contains anthracycline. Combined dexamethasone, cytosine arabinoside, and cisplatin (DHAP) and etoposide, methylprednisolone, cytosine arabinoside, and cisplatin (ESHAP) have shown good response rates in HIV-negative patients with relapsed lymphomas. We retrospectively analyzed patients with refractory or relapsed AIDS-NHL who had been treated with either DHAP or ESHAP to evaluate the feasibility and efficacy of these regimens.Twenty-six patients with refractory or relapsed AIDS-NHL were treated between 1990 and 1999 either with DHAP (n = 13) or with ESHAP (n = 13). Only 1 patient from each group (8%) had achieved complete remission with any previous therapy, and most had progressive disease after the regimen immediately preceding DHAP or ESHAP. In the ESHAP group, 4 patients (31 %) achieved complete remission (CR) and 3 patients (23%) attained partial remission (PR) for an overall response rate of 54%. The median survival was 7.1 months (range, 1-58.9+ months) from the time ESHAP was begun. Among the 3 patients with primary refractory lymphoma, there was 1 CR, 1 PR, and one patient with stable disease. In contrast, only 1 PR (7%) was observed with DHAP; the median survival was 3 months. Myelosuppression was the most significant toxicity with grade 4 neutropenia occurring in all who received ESHAP and in 54% of patients treated with DHAP. Neutropenic fever occurred in 8 (62%) ESHAP-treated and 6 (46%) DHAP-treated patients.Although hematologic toxicity is profound, ESHAP appears to be an active salvage regimen for patients with relapsed or refractory AIDS-NHL.

Address correspondence and reprint requests to Alexandra M. Levine, USC/Norris Cancer Hospital and Research Institute, 1441 East-lake Avenue, Room 3468, Los Angeles, CA 90033 U.S.A.; e-mail:

Manuscript received June 7, 2001; accepted October 3, 2001.

© 2001 Lippincott Williams & Wilkins, Inc.