NEW YORK (Reuters Health) – A pooled analysis of two trials indicates that HIV patients with aggressive B-cell non-Hodgkin lymphoma (NHL) fare better with a regimen of rituximab combined with EPOCH chemotherapy than rituximab plus CHOP chemotherapy.
“Benefits were observed in both high-risk and low-risk patients,” note the authors of the report in Cancer online December 1.
Dr. Stefan K. Barta, at the Albert Einstein College of Medicine, Bronx, New York and colleagues explain that NHL remains the most common malignancy associated with HIV.
Recent trials have indicated that rituximab added to chemotherapy should be the standard of care for such patients, they continue, and that infusional cytotoxic therapy with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) might be more effective than standard CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy.
For the current study, the team pooled data from a trial of rituximab-CHOP and one of rituximab-EPOCH, involving a total of 150 patients, to see if the latter remained advantageous after accounting for age-adjusted International Prognostic Index (aaIPI) and CD4 count.
The likelihood of achieving a complete response was greater in patients with a low aaIPI score (odds ratio 4.6; p<0.001) and in those with a CD4 count of at least 100 cells/microliter (odds ratio 2.7; p=0.01), the investigators report.
When adjusted for those covariates, the event-free survival rate was significantly better with rituximab-EPOCH than rituximab-CHOP (hazard ratio 0.4; p<0 .001), as was overall survival (hazard ratio 0.38; p<0.001), they found.
Treatment-associated mortality was 14% with rituximab-CHOP and 9% with rituximab-EPOCH. Regardless of the regimen, mortality was significantly higher among patients with CD4 counts less than 50 cells/microliter (37%) than those with higher counts (6%; p<0.01), Dr. Barta and colleagues report.
Summing up, they conclude, “These results provide level 2 evidence supporting the use of R-EPOCH for selected patients with HIV-associated B-cell NHL and a CD4 count >50/microliter.”
They add that an ongoing randomized trial should eventually provide level 1 evidence to define the role of rituximab-EPOCH in diffuse large B-cell lymphoma.