Are hematopoietic colony-stimulating factors useful in association with chemotherapy in the treatment of HIV-related non-Hodgkin's lymphomas?

The treatment of patients with HW/AIDS may be complicated by the myelotoxicity of antiretroviral, antiinfective and antineoplastic drugs that often are to be given concomitantly or subsequently when malignancies develop. Moreover, HIV-related bone marrow dysplasia, in particular granulocytopenia, often concomitantly present, could render such treatment, in particular antineoplastic chemotherapy, even more myelotoxic [I-31. However, while hematopoietic colony-stimulating factors (CSF) i.e., granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) have been extensively investigated in cancer patients of the general population [4-6], they have been tested to a sigdicantly lesser extent in the HIV setting [7,8]. Ad hoc committees of the American Society of Clinical Oncology (ASCO) and the European School of Oncology (ESO) recently issued recommendations for the use of CSF in cancer patients receiving antineoplastic chemotherapy [9, 101. Primary administration of CSF is recommended by the ASCO committee for patients who are expected to develop febrile neutropenia with an incidence equal to or more than 40% and in patients at higher risk for chemotherapy-induced infectious complications [9]. Moreover, the ESO committee justifies the use of CSF with the first chemotherapy cycle if life-threatening complications are anticipated or if a reduction in the scheduled dose might endanger long-term success [lo]. Such recommendations are thought by the committees to be applicable also for patients with HIV-related non-Hodgkm's lymphoma (HIV-NHL), although specific indications for such patients are not discussed in detail [9, 101. We wish therefore to review the data published in full articles which have appeared in the literature regarding treatment of HIV-NHL with chemotherapy with or without CSF, and our experience as well, in order to verify whether ASCO and ESO recommendations fully apply also to patients with HIV-NHL who receive antineoplastic chemotherapy. Review of the literature