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document
Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma . Rituximab plus intravenous bolus chemotherapy is a standard treatment for immunocompetent patients with B-cell non-Hodgkin lymphoma ( NHL ) . Some studies have suggested that rituximab is associated with excessive toxicity in HIV-associated NHL , and that infusional chemotherapy may be more effective . We performed a randomized phase 2 trial of rituximab ( 375 mg/m ( 2 ) ) given either concurrently before each infusional etoposide , vincristine , doxorubicin , cyclophosphamide , and prednisone ( EPOCH ) chemotherapy cycle or sequentially ( weekly for 6 weeks ) after completion of all chemotherapy in HIV-associated NHL . EPOCH consisted of a 96-hour intravenous infusion of etoposide , doxorubicin , and vincristine plus oral prednisone followed by intravenous bolus cyclophosphamide given every 21 days for 4 to 6 cycles . In the concurrent arm , 35 of 48 evaluable patients ( 73 % ; 95 % confidence interval , 58 % -85 % ) had a complete response . In the sequential arm , 29 of 53 evaluable patients ( 55 % ; 95 % confidence interval , 41 % -68 % ) had a complete response . The primary efficacy endpoint was met for the concurrent arm only . Toxicity was comparable in the 2 arms , although patients with a baseline CD4 count less than 50/microL had a high infectious death rate in the concurrent arm . We conclude that concurrent rituximab plus infusional EPOCH is an effective regimen for HIV-associated lymphoma .
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Intervention_Pharmacological
Rituximab plus concurrent infusional EPOCH chemotherapy
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Intervention_Pharmacological
rituximab ( 375 mg/m ( 2 ) ) given either concurrently before each infusional etoposide , vincristine , doxorubicin , cyclophosphamide , and prednisone ( EPOCH ) chemotherapy cycle or sequentially ( weekly for 6 weeks ) after completion of all chemotherapy in HIV-associated NHL . EPOCH
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Intervention_Pharmacological
etoposide , doxorubicin , and vincristine plus oral prednisone
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Intervention_Pharmacological
cyclophosphamide
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Intervention_Pharmacological
concurrent rituximab plus infusional EPOCH
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Outcome_Physical
excessive toxicity
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Outcome_Other
complete response
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Outcome_Physical
Toxicity
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Outcome_Physical
CD4
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Outcome_Mortality
infectious death
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Participant_Condition
in HIV-associated B-cell non-Hodgkin lymphoma .
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Participant_Condition
NHL
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Participant_Condition
HIV-associated NHL
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Participant_Sample-size
48
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Participant_Sample-size
53
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Participant_Condition
HIV-associated lymphoma