Early studies reported that the major adverse prognostic factors in
AIDS-related
non-Hodgkin's lymphoma (ARL) are low CD4 cell count, prior
AIDS defining diagnosis and poor performance status. Since 1989 we have adopted a prognosis-stratified approach for ARL. In this study, we identified a group of good prognosis patients. These patients with one or no adverse prognostic factors were treated with alternating weekly
chemotherapy using the
bleomycin,
etoposide,
vincristine,
methotrexate,
prednisolone/
cyclophosphamide,
doxorubicin (BEMOP/CA) schedule (Bower M, Block C, Gulliford T, et al.
Cancer Chemother Pharmacol 1995, 38, 106-109). Modifications to the regimen with the aim of reducing toxicity were a briefer duration (12 weeks) and the addition of prophylaxis against pneumocystis and mycobacteria. Intrathecal
methotrexate was administrated fortnightly to patients with Burkitt's histology, meningeal involvement or base of skull disease. 30 patients were treated, including 5 with prior
AIDS, 3 with ECOG status 3 and 1 with CD4 <100/microl. The mean age was 40 (range 22-60 years), the median CD4 cell count at ARL diagnosis was 262/microl (range 44-588/microl). The International
non-Hodgkin's lymphoma (NHL) prognostic factors project classifications were low risk 8 (maximum 5.4 years) (27%), low-intermediate risk 6 (20%), high-intermediate risk 11 (37%) and high risk 5 (17%). The median follow-up was 2.1 years. 3 patients withdrew from treatment within 2 weeks due to toxicity, 2 patients died within 2 weeks of starting
chemotherapy. The major toxicity was myelosuppression with 14 patients developing grade 4
neutropenia. The 2-year overall survival rate is 46% (95% confidence interval (CI)=27-65%), and
lymphoma-specific survival at 2 years is 59% (95% CI: 40-78%). For selected patients with good prognosis ARL 12 weeks BEMOP/CA
therapy produces good overall survival at 2 years.