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Prepublished online as a Blood First Edition Paper on June 7, 2002; DOI 10.1182/blood-2002-03-0989.
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Blood, 15 September 2002, Vol. 100, No. 6, pp. 1984-1988
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Stanford V regimen and concomitant HAART in 59 patients
with Hodgkin disease and HIV infection
Michele Spina,
Jean Gabarre,
Giuseppe Rossi,
Marco Fasan,
Clara Schiantarelli,
Ezio Nigra,
Maurizio Mena,
Andrea Antinori,
Adriana Ammassari,
Renato Talamini,
Emanuela Vaccher,
Giampiero di
Gennaro, and
Umberto Tirelli
From the Division of Medical Oncology A and the
Epidemiology Unit, National Cancer Institute, Aviano, Italy; the
Department of Hematology, Hospital Pitié Salpetrière,
Paris, France; the Hematology Unit, Spedali Civili, Brescia, Italy; the
Department of Infectious Diseases, Sacco Hospital, and the Division of
Infectious Diseases, Niguarda Hospital, Milan, Italy; the Division of
Infectious Diseases B, Amedeo di Savoia Hospital, Turin, Italy; the
Division of Infectious Diseases, Cuggiono Hospital, Cuggiono, Italy;
and the Department of Clinical Research, IRCCS Spallanzani, and the
Department of Infectious Diseases, Catholic University, Rome, Italy.
A phase 2 prospective study was performed to evaluate the
feasibility and activity of a short, dose-intensive chemotherapy regimen and radiotherapy (the Stanford V regimen) plus highly active
antiretroviral therapy (HAART) and granulocyte colony-stimulating factor (G-CSF) support in patients with Hodgkin disease and HIV infection. Fifty-nine patients were enrolled. Stanford V was well tolerated and 69% of the patients completed treatment with no dose
reduction or delayed chemotherapy administration. The most important
dose-limiting side effects were bone marrow toxicity and neurotoxicity.
Complete remission was achieved by 81% of the patients, and after a
median follow-up of 17 months 33 patients (56%) were alive and
disease-free. The estimated 3-year overall survival (OS), disease-free
survival (DFS), and freedom from progression (FFP) were 51%, 68%, and
60%, respectively. Probability of FFP was significantly
(P = .02) higher among patients with an International Prognostic Score (IPS) of 2 or lower than in those with an IPS higher
than 2, and the percentages of FFP at 2 years in these groups were 83%
and 41%, respectively. Similarly, the probability of OS was
significantly (P =.0004) different in the 2 groups, and the
percentages of OS at 3 years were 76% and 33%, respectively. Our data
confirm that the Stanford V regimen with concomitant HAART is feasible
and active in an HIV setting. However, a more intensive approach should
be considered in patients with high IPSs.
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