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Lawrence D. Kaplan, MD; Donald I. Abrams, MD; Ellen Feigal, MD; Michael McGrath, MD, PhD; James Kahn, MD; Padraic Neville, MS; John Ziegler, MD; Paul A. Volberding, MD

JAMA. 1989;261(5):719-724.

Abstract
The characteristics of acquired immunodeficiency syndrome—associated non-Hodgkin's lymphoma in 84 patients diagnosed and treated at San Francisco General Hospital are presented herein. While the majority were high-grade B-cell lymphomas, one cutaneous T-cell and one peripheral T-cell lymphoma were observed. In addition, three other tumors were suspicious for T-cell lymphoma. Sixty-seven percent of patients had stage IV disease, often at unusual sites. Epstein-Barr virus DNA sequences were identified in only five of 15 tumors by dot-blot analysis. Patients were treated with a variety of standard chemotherapeutic regimens, with radiation therapy alone, or with a novel chemotherapy protocol (COMET-A). No significant differences in complete response rates were observed. The most important predictor of survival was the total number of CD4-positive lymphocytes. Other predictors of survival included history of a diagnosis of acquired immunodeficiency syndrome, Karnofsky performance score, and the presence of extranodal disease. Survival was shorter among patients who received higher doses of cyclophosphamide (>1 g/m²), including those treated with the COMET-A regimen. Implications for therapeutic decision making are discussed.

(JAMA 1989;261:719-724)

Author Affiliations
From the Department of Medicine, San Francisco General Hospital (Drs Kaplan, Abrams, Feigal, McGrath, Kahn, and Volberding and Mr Neville); San Francisco Veterans Administration Medical Center (Dr Ziegler); and the Cancer Research Institute, University of California, San Francisco (Drs Kaplan, Abrams, Feigal, McGrath, Kahn, Ziegler, and Volberding).

Footnotes
Reprint requests to San Francisco General Hospital, Ward 84, Bldg 80, 995 Potrero Ave, San Francisco, CA 94110 (Dr Kaplan).

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