AIDS-Associated Non-Hodgkin's Lymphoma in San Francisco
- 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
- 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).
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)
Footnotes
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Reprint requests to San Francisco General Hospital, Ward 84, Bldg 80, 995 Potrero Ave, San Francisco, CA 94110 (Dr Kaplan).
