Treatment of AIDS-associated anaplastic large-cell lymphoma with dose-adjusted EPOCH chemotherapy

Anaplastic large-cell lymphoma (ALCL) has rarely been described in patients with acquired immunodeficiency syndrome (AIDS). Reports of treatment of ALCL in the setting of AIDS are rare as well. Dose-adjusted EPOCH (DA-EPOCH; etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) has been shown to be well tolerated and effective in the treatment of AIDS-related aggressive B-cell lymphomas. Treatment of AIDS-associated ALCL with DA-EPOCH has not been reported. This report describes two patients with AIDS-associated ALCL treated with DA-EPOCH chemotherapy. Both patients presented with advanced disease. Excellent clinical response was observed in both patients. The first patient completed six cycles of chemotherapy and remains in complete remission at 12 months of follow up. The second patient has received 2 cycles of chemotherapy thus far. She had an excellent response with rapid improvement of cutaneous disease and lymphadenopathy starting three days after the first cycle. Repeat imaging after two cycles of chemotherapy showed marked radiologic improvement as well. Chemotherapy was well tolerated by both patients. Our experience suggests that DA-EPOCH is an effective treatment for AIDS-associated ALCL.