combination chemotherapy in treating patients with hodgkin's disease and hiv infection

Conditions: Lymphoma

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. combining more than one drug may kill more tumor cells. purpose: phase ii trial to study the effectiveness of two combination chemotherapy regimens in treating patients with hodgkin's disease and hiv infection.

objectives: * investigate the effects on survival, life expectancy and quality, toxicity, and immunological status in low risk patients with hodgkin's disease and hiv infection treated with the stanford v regimen and in high risk patients treated with epirubicin, bleomycin, vinblastine, and prednisone. outline: patients are stratified into 2 groups designated as low and high risk on the basis of ecog performance status (0-2 vs 3-4), presence or absence of aids before the diagnosis of hodgkin's disease, and immune status (cd4+ cell count greater vs no greater than 100/mm\^3). * low risk patients (those with no risk factors) receive the ebvp regimen, as follows: * epirubicin intravenously on day 1 * bleomycin intramuscularly or intravenously on day 1 * vinblastine intravenously on day 1 * prednisone orally on days 1-5 * patients also receive daily injections of filgrastim (granulocyte colony-stimulating factor; g-csf) on days 6-15. this schedule is repeated every 3 weeks for 6 courses. * high risk patients (those with one or more risk factors) receive the stanford v regimen, as follows: * doxorubicin and vinblastine intravenously on days 1 and 15 * mechlorethamine intravenously on day 1 * vincristine and bleomycin intravenously on days 8 and 22 * etoposide intravenously on days 15 and 16 * prednisone orally daily * patients also receive daily injections of g-csf on days 3-7, 9-13, 17-21, and 23-26. this schedule is repeated every 28 days for 3 courses. patients are followed every 2 months the first year and then every 3 months thereafter. projected accrual: 20-30 patients will initially be accrued in this study.

Eligibility criteria:
disease characteristics: * histologically proven hodgkin's disease: * clinical or pathologic stage ii - iv * stage i with bulky disease (tumor size greater than 10 cm) and b symptoms * confirmed hiv infection patient characteristics: age: * 18 and over performance status: * who 0-4 life expectancy: * not specified hematopoietic: * not specified hepatic: * not specified renal: * not specified cardiovascular: * no severe cardiac disease pulmonary: * no severe pulmonary disease other: * no severe neurologic or metabolic disease * no concurrent or prior second malignancy except: * nonmelanomatous skin cancer * in situ cancer of the cervix prior concurrent therapy: biologic therapy * not specified chemotherapy * not specified endocrine therapy * not specified radiotherapy * not specified surgery * not specified other * no prior therapy for hodgkin's disease * concurrent triple-drug antiretroviral therapy (including one protease inhibitor) required

Keywords: stage i adult hodgkin lymphoma stage ii adult hodgkin lymphoma stage iii adult hodgkin lymphoma stage iv adult hodgkin lymphoma aids-related peripheral/systemic lymphoma hiv-associated hodgkin lymphoma