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1244 Part IX: Lymphocytes and Plasma Cells Chapter 81: Hematologic Manifestations of Acquired Immunodeficiency Syndrome 1245

Diffuse Large B-Cell Lymphoma
20 000
18 000
16 000
No. of U.S. Cases 12 000 With AIDS
14 000
10 000
8000
Without AIDS
6000
4000
2000
0
1980 1985 1990 1995 2000 2005
Year

Burkitt Lymphoma
1600
1400
1200
No. of U.S. Cases 1000

800
600
400
200
0
1980 1985 1990 1995 2000 2005
Year

Central Nervous System Lymphoma
1800
1600
1400
No. of U.S. Cases 1000
1200

800
600
400
200
0
1980 1985 1990 1995 2000 2005
Year
Figure 81–1. Number of AIDS-defining cancer cases in the United States in persons with and without AIDS by calendar year. (Reproduced with per-
mission from Shiels MS, Pfeiffer RM, Hall HI, et al.: Proportions of Kaposi sarcoma, selected non-Hodgkin lymphomas, and cervical cancer in the United States
occurring in persons with AIDS, 1980-2007. JAMA 13;305(14):1450–1459, 2011.)

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initial CD4 count greater than 100 cells/μL had an 87 percent overall lymphoma and 25 percent had mainly Burkitt lymphoma). Adminis-
survival at 53 months, whereas those with CD counts of less than 100 tration of EPOCH with concurrent rituximab resulted in a high complete
cells/μL had a 16 percent overall survival at 53 months. A larger mul- response rate (73 percent) in comparison to EPOCH with sequential
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tiinstitution study done by the AIDS Malignancy Consortium (AMC- rituximab (55 percent complete response rate). The National Cancer
034) randomized patients to receive EPOCH with concurrent rituximab Institute evaluated short-course EPOCH with dose-dense rituximab
versus EPOCH with sequential rituximab (given weekly for 6 weeks (rituximab day 1 and day 5 of each cycle of EPOCH), and achieved an
following completion of EPOCH) in 101 patients with HIV-associated overall survival of 68 percent at 5 years in 33 patients with diffuse large
NHL (approximately 75 percent of the patients had diffuse large B-cell B-cell lymphoma. In this study, the initial cyclophosphamide dose
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