Long-term survival in patients with human immunodeficiency virus-associated small non-cleaved cell lymphoma: the role for short course intensive chemotherapy

While intensive chemotherapy is recommended for the treatment of non‐HIV related adult small non‐cleaved lymphoma (SNCL), including Burkitt's and Burkitt‐like lymphoma, optimal treatment for patients with HIV‐associated SNCL is not known. We assessed remissions and survival in a cohort of 44 consecutive HIV positive patients diagnosed with SNCL at our hospital between June 2000 and November 2001 using chart and pathology data. Median follow‐up, survival and survival at the median follow‐up time were 4.5 months, 4 months and 49% respectively. Of this cohort 39% were complete responders (CR) and 36% were long‐term lymphoma‐free survivors. Two patients relapsed from CR. Short course intensive chemotherapy (McMaster) was administered to 23 patients; 17 received less intensive conventional combination chemotherapy; and four received single‐agent chemotherapy or no treatment. In the McMaster group, 38% (9/23) achieved CR with no relapses. Seven patients (30%) died of toxicity compared with one (6%) in the less intensively treated group. Of the stage I patients, 75% (6/8) achieved long‐term CR with half being treated conventionally. Conventional chemotherapy may be curative for early stage HIV‐SNCL. In advanced disease, McMaster chemotherapy was found to be associated with substantial early mortality but was curative in a significant number of patients. Copyright © 2003 John Wiley & Sons, Ltd.