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Potent Burkitt's lymphoma therapy appropriate in HIV patients
  By David Douglas
NEW YORK (Reuters Health) - HIV patients undergoing highly active antiretroviral therapy (HAART) are able to tolerate intensive Burkitt's lymphoma therapy and should be given treatment comparable to that in patients without HIV, researchers report in the July 1st issue of the Journal of Clinical Oncology.
Standard therapy for HIV-Burkitt's lymphoma and HIV-diffuse large cell lymphoma, they note, is cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or methotrexate, bleomycin, cyclophosphamide, etoposide (m-BACOD).
"Prior to the availability of HAART, when median survival for AIDS lymphoma was only approximately 6 months," senior investigator Dr. Alexandra M. Levine told Reuters Health, "there was no difference in survival times between patients with Burkitt's lymphoma, or with diffuse large cell types, and all pathologic types were treated in the same way, with m-BACOD or CHOP-like regimens."
HAART, she continued, "has now resulted in significant improvement in survival among patients with large cell lymphoma, but not in those with Burkitt's, who would ordinarily be treated with much more dose-intensive regimens than standard CHOP."
Dr. Levine of the University of Southern California, Los Angeles and colleagues found that pre-HAART era survival in HIV-Burkitt's patients was 6.4 months versus 8.3 months in those with diffuse large-cell lymphoma.
However in the HAART era, of 101 patients, survival of those with Burkitt's was 5.7 months versus 43.2 months for large cell lymphoma.
The researchers point out that in general, experience over the last 3 decades has confirmed that dose-intensive chemotherapy increases survival in patients with Burkitt's lymphoma.
"With the potential of HAART to improve survival due to HIV as well as the tolerability of chemotherapy, patients with AIDS-related Burkitt lymphoma should now be treated much more intensively, as would be routine in Burkitt's patients without HIV infection," Dr. Levine said.
J Clin Oncol 2005;23:4430-4438.
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