Aggressive anti-viral treatment allows patients to receive standard doses of chemotherapy and may ultimately improve survival for patients with HIV-related Non-Hodgkin’s lymphoma, according to recent results published in the Journal of Clinical Oncology.

Non-Hodgkin’s lymphoma is a cancer of the lymph tissue, which is part of the immune system in the body. Lymph tissue is present in lymph nodes, lymph vessels and bone marrow, which exist throughout the body. It is also present in organs such as the thymus, tonsils and spleen. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. The large majority of NHL cases involve cancer of the B-lymphocytes, characterized by the excessive multiplication of these atypical cells. These cancerous cells can crowd lymph tissue causing suppression of normal formation and function of other cells normally found in this tissue. Because lymphocytes can travel virtually anywhere in the body through blood or lymph fluid, lymphomas can occur in sites other than lymph tissue, such as the gastrointestinal tract or the brain.

Individuals with the human immunodeficiency virus (HIV) have a much higher incidence of non-Hodgkin's lymphoma (NHL) compared to individuals without the virus. Because HIV weakens the immune (infection fighting) system of the body, NHL treatment has not been aggressive and is associated with a poor prognosis. Recently, however, researchers have reported that the use of intensive anti-viral therapy allows standard, higher doses of chemotherapy to be tolerated in individuals with HIV related NHL, which may increase survival rates. Patients with HIV related NHL often have fast-growing, or high-grade lymphomas that tend to develop outside of the lymph system.

Chemotherapy, the standard treatment for NHL, targets and kills rapidly dividing cells, such as cancer cells. Although chemotherapy is effective at killing cancer cells, treatment does not differentiate between cancer cells and healthy cells. Higher doses of chemotherapy kill more cancer cells than lower doses. Unfortunately, higher doses of chemotherapy also kill more normal cells. Because patients with HIV already have a compromised immune system and often have other medical complications, aggressive treatment with standard or high-dose chemotherapy can cause potentially lethal side effects. Therefore, lower-dose chemotherapy has historically been used for treatment against HIV related NHL. However, standard or high-dose chemotherapy is needed in order to obtain the most effective results.

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Researchers from 17 U.S. medical centers recently reported that higher doses of chemotherapy following aggressive anti-viral treatment were well tolerated in patients with HIV related NHL. This trial involved 65 HIV patients with previously untreated NHL. Prior to chemotherapy, these patients received intensive anti-viral treatment consisting of multiple agents. The first 40 patients received reduced doses of cyclophosphamide and doxorubicin combined with vincristine and prednisone (modified CHOP) and the following 25 received full doses of CHOP combined with granulocyte colony-stimulating factor (G-CSF).

Thirty percent of patients who received modified doses achieved a complete disappearance of their cancer, while 48% of patients who received higher doses of chemotherapy achieved a complete disappearance of their cancer. These doctors concluded that either modified-dose or full-dose chemotherapy for HIV-NHL, delivered with anti-viral therapy was effective and tolerable. The average duration of complete responses for patients receiving modified CHOP was 9 months and the average duration for patients receiving full doses of CHOP has not yet been reached.

These findings indicate that modern anti-viral therapy allowed patients to tolerate standard, higher doses of chemotherapy for the treatment of HIV related NHL. Complete disappearances and durations of responses of patients who received higher doses of chemotherapy were improved, compared with patients who received moderate doses. Clinical trials are ongoing to further evaluate intensive treatments including stem cell transplantation in order to provide the most effective treatment strategy for individuals with HIV-related NHL. Patients with HIV-related NHL may wish to talk to their physicians about the risks and benefits of participating in ongoing clinical trials utilizing this type of treatment or other promising treatments. Two sources of information on ongoing clinical trials that can be discussed with a doctor include comprehensive, easy to use clinical listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Journal of Clinical Oncology, Vol 19, Issue 8, pp 2171-2178, 2001)

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