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Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma

Primary Purpose

Lymphoma

Status

Completed

Phase

Phase 1

Locations

United States

Study Type

Interventional

Intervention

rituximab

bortezomib

carboplatin

dexamethasone

etoposide

ifosfamide

polymerase chain reaction

western blotting

About this trial

This is an interventional treatment trial for Lymphoma focused on measuring AIDS-related diffuse large cell lymphoma, AIDS-related diffuse mixed cell lymphoma, AIDS-related diffuse small cleaved cell lymphoma, AIDS-related immunoblastic large cell lymphoma, AIDS-related lymphoblastic lymphoma, AIDS-related peripheral/systemic lymphoma, AIDS-related primary CNS lymphoma, AIDS-related small noncleaved cell lymphoma

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed relapsed or refractory HIV-associated non-Hodgkin lymphoma (NHL)
- Must have histologic or cytologic documentation of prior AIDS-associated NHL (i.e., at time of diagnosis) for clinically relapsed and/or refractory disease for which biopsy is not feasible
- Must have documented HIV seropositivity
- Must have documentation of Epstein-Barr Virus (EBV)- and/or human herpes virus-8 (HHV-8)- positive infection within the lymphoma (i.e., LMP-1, LANA expression, or positive Epstein-Barr-encoded RNAs [EBERs])

PATIENT CHARACTERISTICS:

Inclusion criteria:

ECOG performance status (PS) 0-2 OR Karnofsky PS 50-100%
Life expectancy > 2 months
ANC ≥ 1,000/mm³* (growth factor support allowed)
Hemoglobin ≥ 8.0 g/dL* (growth factor support allowed)
Platelet count ≥ 100,000/mm³
Total bilirubin ≤ 1.5 mg/dL
AST/ALT ≤ 2.5 times institutional upper limit of normal (ULN)
Serum creatinine ≤ ULN
Creatinine clearance ≥ 50 mL/min
Negative pregnancy test
Not pregnant or nursing
Fertile patients must use effective contraception NOTE: *Patients with lymphomatous involvement of the bone unable to meet hematologic criteria are allowed

Exclusion criteria:

Peripheral neuropathy ≥ grade 2
Uncontrolled intercurrent illness including, but not limited to, any of the following:
- Ongoing or active infection
  - Opportunistic infections controlled by antimicrobial or suppressive therapy allowed, unless the investigator judges the infection likely to become life-threatening in the setting of multi-agent chemotherapy
- Symptomatic congestive heart failure
- Unstable angina pectoris
- NYHA class III or IV heat failure
- Myocardial infarction within the past 6 months
- Uncontrolled angina
- Severe uncontrolled ventricular or other cardiac arrhythmias
- Acute ischemia or active conduction system abnormalities by ECG
- Serious psychiatric or medical illness, that would interfere with study compliance
Social situations that would interfere with study compliance
Acute active HIV-associated opportunistic infection requiring antibiotic treatment
- Mycobacterium avium or candidiasis allowed unless concurrent therapy with moderate-to-strong CYP3A4 inducers or inhibitors is required
- Chronic myelosuppressive agent therapy allowed provided hematologic criteria are met
Hypersensitivity to compounds of similar chemical or biological composition to bortezomib, boron, mannitol, ifosfamide, carboplatin, or etoposide
Concurrent malignancy except carcinoma in situ of the cervix, in situ anal cancer, nonmetastatic nonmelanoma skin cancer, or Kaposi's sarcoma not requiring systemic chemotherapy
Active hepatitis B infection (hepatitis B surface antigen-positive), unless 1 of the following criteria are met:
- Able to start dual anti-hepatitis B adefovir and telbivudine therapy prior to study
- Receiving dual anti-hepatitis B therapy for at least 12 weeks prior to study with either agent active against HIV (i.e., entecavir, tenofovir, lamivudine, or emtricitabine)
Concurrent grapefruit juice/fruit or green tea

PRIOR CONCURRENT THERAPY:

See Disease Characteristics
Recovered from prior adverse effects due to agents administered more than 3 weeks earlier
Glucocorticoid therapy within the past 3 weeks allowed
More than 3 weeks since prior chemotherapy
More than 2 weeks since prior radiotherapy
More than 14 days since prior and no other concurrent investigational agents (other than bortezomib)
No concurrent moderate-to-strong CYP3A4 inducers or inhibitors other than protease inhibitors
Concurrent stable (at least 12 weeks) antiretroviral regimen allowed

Sites / Locations

Rebecca and John Moores UCSD Cancer Center
USC/Norris Comprehensive Cancer Center and Hospital
UCLA Clinical AIDS Research and Education (CARE) Center
University of California at Davis Center for Aids Research and Education Services
University of Miami Sylvester Comprehensive Cancer Center - Miami
Emory Winship Cancer Institute
Cancer Research Center of Hawaii
Northwestern Cancer Center
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Beth Israel Deaconess Medical Center
Montefiore Medical Center
Memorial Sloan-Kettering Cancer Center
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center
Pennsylvania Oncology Hematology Associates, Incorporated - Philadelphia
Thomas Street Health Center
Baylor College of Medicine
Virginia Mason Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Arm Label

CD20+ Non-Hodgkin Lymphoma

CD20- Non-Hodgkin Lymphoma

Arm Description

Part A: Velcade Day 1 and Day 8, with inter-subject dose escalation over four dose levels: 0.7 mg/m2, 1 mg/m2, 1.3 mg/m2 and 1.5 mg/m2. Dexamethasone 20 mg IV and etoposide 100 mg/m2 IV Days 8-10, carboplatin dosed to AUC=5 (maximum 750 mg) IV and ifosfamide 5000 mg/m2 mixed with an equal amount of Mesna on Day 9 of a 28-day cycle. Part B: Velcade on Days 1 and 8, dexamethasone 20 mg IV Days 1-3 and Day 8; etoposide 100 mg/m2 IV on Days 1-3; carboplatin dosed to AUC=5 (maximum 750 mg) IV on Day 2; ifosfamide 5000 mg/m2 mixed with an equal amount of Mesna and administered as a continuous IV infusion over 24 hours on Day 2, rituximab 375mg/m2 on Day 1 of a 21-day cycle.

Outcomes

Primary Outcome Measures

Maximum tolerated dose of bortezomib

Overall lymphoma response rate

Safety as assessed using the CTCAE

Secondary Outcome Measures

Median overall survival at 1 year

Impact of bortezomib alone and in combination with rituximab, ifosfamide, carboplatin, and etoposide ([R]ICE) on serum HIV viral loads and APOBEC3G levels

Impact of bortezomib alone and in combination with (R)ICE on EBV and HHV-8 lytic activation using serum viral loads

Safety of bortezomib alone in patients with relapsed or refractory AIDS-associated lymphomas

Correlation of EBV/HHV-8 viral load changes with lymphoma response

Comparison of above outcomes to a parallel protocol employing ICE +/- rituximab in patients with EBV/HHV-8-negative AIDS-NHL to assess whether bortezomib has additional effects beyond (R)ICE alone

Full Information

NCT ID

NCT00598169

First Posted

January 9, 2008

Last Updated

August 7, 2020

Sponsor

AIDS Malignancy Consortium

Collaborators

National Cancer Institute (NCI), The Emmes Company, LLC

1. Study Identification

Unique Protocol Identification Number

NCT00598169

Brief Title

Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma

Official Title

Safety and Efficacy Pilot Trial of the Anti-Viral and Anti-Tumor Activity of Velcade Combined With (R)ICE in Subjects With EBV and/or HHV-8 Positive Relapsed/Refractory AIDS-Associated Non-Hodgkin's Lymphoma

Study Type

Interventional

2. Study Status

Record Verification Date

August 2020

Overall Recruitment Status

Completed

Study Start Date

November 2007 (undefined)

Primary Completion Date

October 2014 (Actual)

Study Completion Date

November 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

AIDS Malignancy Consortium

Collaborators

National Cancer Institute (NCI), The Emmes Company, LLC

4. Oversight

Data Monitoring Committee

5. Study Description

Brief Summary

RATIONALE: Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. Drugs used in chemotherapy, such as dexamethasone, ifosfamide, carboplatin, and etoposide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. It is not yet known whether giving bortezomib together with combination chemotherapy is more effective with or without rituximab in treating AIDS-related non-Hodgkin lymphoma. PURPOSE: This clinical trial is studying giving bortezomib together with dexamethasone, ifosfamide, carboplatin, and etoposide to see how well it works with or without rituximab in treating patients with relapsed or refractory AIDS-related non-Hodgkin lymphoma.

Detailed Description

OBJECTIVES: Primary Evaluate the safety and overall lymphoma response rate of bortezomib in combination with ifosfamide, carboplatin, and etoposide (ICE) with or without rituximab in patients with Epstein-Barr Virus (EBV)- and/or human herpes virus-8 (HHV-8)- positive relapsed or refractory HIV-associated non-Hodgkin lymphoma (NHL). Secondary Evaluate the impact of bortezomib alone and in combination with rituximab) and ICE ([R] ICE) on serum HIV viral loads and APOBEC3G levels. Estimate the impact of bortezomib alone and in combination with (R)ICE on EBV and HHV-8 lytic activation using serum viral loads. Estimate the median response duration and 1 year overall survival rate of patients treated with this regimen. Evaluate the safety of bortezomib alone in patients with relapsed or refractory AIDS-associated lymphomas. Correlate EBV/HHV-8 viral load changes with lymphoma response. Compare the above outcomes to a parallel protocol employing ICE with or without rituximab in patients with EBV/HHV-8-negative AIDS-NHL to assess whether bortezomib has additional effects beyond (R)ICE alone. OUTLINE: This is a multicenter, dose-escalation study of bortezomib. Patients are assigned to 1 of 2 treatment groups. CD20-negative patients Part A: Patients receive bortezomib IV over 3-5 seconds on days 1 and 8, dexamethasone IV and etoposide IV over 2 hours on days 8-10, and ifosfamide IV continuously over 24-hours and carboplatin IV over 2 hours on day 9. Treatment repeats every 28 days until the maximum tolerated dose (MTD) is determined. Patients who tolerate the MTD of bortezomib may move on to part B. Part B: Patients receive bortezomib IV over 3-5 seconds at the MTD on days 1 and 8, dexamethasone IV on days 1-3 and 8, etoposide IV over 2 hours on days 1-3, and ifosfamide IV continuously over 24-hours and carboplatin IV over 2 hours on day 2. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Some patients may undergo hematopoietic stem cell transplantation (HSCT). CD20-positive patients Part A: Patients receive bortezomib, dexamethasone, etoposide, ifosfamide, and carboplatin as in the CD20-negative patients part A group. Part B: Patients receive rituximab IV on day 1. Patients also receive bortezomib, dexamethasone, etoposide, ifosfamide, and carboplatin as in the CD20-negative patients part B group. Some patients may undergo HSCT. Patients undergo blood sample collection periodically for correlative studies. Samples are analyzed for the effects of bortezomib on viral activation and replication via Taqman polymerase chain reaction (PCR), and for quantification of APOBEC3G levels via western blot. Similar studies are performed on the BCLB-1 EBV containing lines, as well as Daudi and other EBV-transformed B-lymphocyte lines via quantitative viral DNA PCR. Patients complete the Functional Assessment of Cancer Therapy/GOG-Neurotoxicity Questionnaire, v4.0 at day 8 and week 4 of Part A and at least once per course of Part B for assessment of neuropathic pain and/or peripheral neuropathy. After completion of study treatment, patients achieving complete response (CR) are followed at 2-4 weeks and then every 3 months for 1 year. Patients not achieving CR at completion of study treatment and declining further antineoplastic treatment are followed at 2-4 weeks and then every 3 months for 1 year.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Lymphoma

Keywords

AIDS-related diffuse large cell lymphoma, AIDS-related diffuse mixed cell lymphoma, AIDS-related diffuse small cleaved cell lymphoma, AIDS-related immunoblastic large cell lymphoma, AIDS-related lymphoblastic lymphoma, AIDS-related peripheral/systemic lymphoma, AIDS-related primary CNS lymphoma, AIDS-related small noncleaved cell lymphoma

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 1

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

Non-Randomized

Enrollment

23 (Actual)

8. Arms, Groups, and Interventions

Arm Title

CD20+ Non-Hodgkin Lymphoma

Arm Type

Experimental

Arm Description

Arm Title

CD20- Non-Hodgkin Lymphoma

Arm Type

Experimental

Arm Description

Intervention Type

Biological

Intervention Name(s)

rituximab

Intervention Description

375mg/m2 on Day 1

Intervention Type

Drug

Intervention Name(s)

bortezomib

Intervention Description

Part A: Velcade Day 1 and Day 8 of a 28-day cycle, with inter-subject dose escalation over four dose levels: 0.7 mg/m2, 1 mg/m2, 1.3 mg/m2 and 1.5 mg/m2 Part B: Velcade on Days 1 and 8 of a 21-day cycle.

Intervention Type

Drug

Intervention Name(s)

carboplatin

Intervention Description

Carboplatin will be dosed to an AUC=5, calculated using the Calvert formula (5 x [creatinine clearance + 25]; the maximum dose of carboplatin is 750 mg. Part A: AUC=5 (maximum 750 mg) IV administered on Day 9. Part B: AUC=5 (maximum 750 mg) IV administered on Day 2.

Intervention Type

Drug

Intervention Name(s)

dexamethasone

Intervention Description

Part A: 20 mg IV on Days 8-10. Part B: 20 mg IV on Days 1-3 and on Day 8.

Intervention Type

Drug

Intervention Name(s)

etoposide

Intervention Description

Part A: 100 mg/m2 IV Days 8-10. Part B: 100 mg/m2 IV daily on Days 1 to 3.

Intervention Type

Drug

Intervention Name(s)

ifosfamide

Intervention Description

Part A: 5000 mg/m2 mixed with an equal amount of Mesna as a 24 hour continuous IV infusion on Day 9. Part B: 5000 mg/m2 mixed with an equal dose of Mesna administered via continuous infusion for 24 hours beginning on Day 2.

Intervention Type

Genetic

Intervention Name(s)

polymerase chain reaction

Intervention Description

Correlate EBV/HHV-8 viral load changes with lymphoma response. HIV and EBV/HHV-8 viral loads will be assessed on baseline, day 2, 4, and 8 of week 1 of Part A.

Intervention Type

Genetic

Intervention Name(s)

western blotting

Intervention Description

Peripheral blood mononuclear cells will be collected at Day 1 prior to chemotherapy, Day 2, 4 and 8 (prior to chemotherapy) then weekly during Part A, just prior to each additional cycle of Part B and at treatment completion. Western blot using antibody specific for APOBEC3G and antibody against actin for internal control will be used to quantify APOBEC3G levels. Changes at will be compared with baseline using a paired t-test.

Primary Outcome Measure Information:

Title

Maximum tolerated dose of bortezomib

Time Frame

Assessed at end of cycle 1 for each group of 3 subjects

Title

Overall lymphoma response rate

Time Frame

End of treatment

Title

Safety as assessed using the CTCAE

Time Frame

Every cycle of treatment and all post-treatment visits

Secondary Outcome Measure Information:

Title

Median overall survival at 1 year

Time Frame

1 year post-treatment

Title

Impact of bortezomib alone and in combination with rituximab, ifosfamide, carboplatin, and etoposide ([R]ICE) on serum HIV viral loads and APOBEC3G levels

Time Frame

baseline, day 2, 4, and 8 of week 1 of Part A, end of treatment

Title

Impact of bortezomib alone and in combination with (R)ICE on EBV and HHV-8 lytic activation using serum viral loads

Time Frame

baseline, day 2, 4, and 8 of week 1 of Part A, end of treatment

Title

Safety of bortezomib alone in patients with relapsed or refractory AIDS-associated lymphomas

Time Frame

Every cycle of treatment and all post-treatment visits

Title

Correlation of EBV/HHV-8 viral load changes with lymphoma response

Time Frame

baseline, day 2, 4, and 8 of week 1 of Part A, end of treatment

Title

Comparison of above outcomes to a parallel protocol employing ICE +/- rituximab in patients with EBV/HHV-8-negative AIDS-NHL to assess whether bortezomib has additional effects beyond (R)ICE alone

Time Frame

Upon availability of both studies' results

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

120 Years

Accepts Healthy Volunteers

Eligibility Criteria

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed relapsed or refractory HIV-associated non-Hodgkin lymphoma (NHL) Must have histologic or cytologic documentation of prior AIDS-associated NHL (i.e., at time of diagnosis) for clinically relapsed and/or refractory disease for which biopsy is not feasible Must have documented HIV seropositivity Must have documentation of Epstein-Barr Virus (EBV)- and/or human herpes virus-8 (HHV-8)- positive infection within the lymphoma (i.e., LMP-1, LANA expression, or positive Epstein-Barr-encoded RNAs [EBERs]) PATIENT CHARACTERISTICS: Inclusion criteria: ECOG performance status (PS) 0-2 OR Karnofsky PS 50-100% Life expectancy > 2 months ANC ≥ 1,000/mm³* (growth factor support allowed) Hemoglobin ≥ 8.0 g/dL* (growth factor support allowed) Platelet count ≥ 100,000/mm³ Total bilirubin ≤ 1.5 mg/dL AST/ALT ≤ 2.5 times institutional upper limit of normal (ULN) Serum creatinine ≤ ULN Creatinine clearance ≥ 50 mL/min Negative pregnancy test Not pregnant or nursing Fertile patients must use effective contraception NOTE: *Patients with lymphomatous involvement of the bone unable to meet hematologic criteria are allowed Exclusion criteria: Peripheral neuropathy ≥ grade 2 Uncontrolled intercurrent illness including, but not limited to, any of the following: Ongoing or active infection Opportunistic infections controlled by antimicrobial or suppressive therapy allowed, unless the investigator judges the infection likely to become life-threatening in the setting of multi-agent chemotherapy Symptomatic congestive heart failure Unstable angina pectoris NYHA class III or IV heat failure Myocardial infarction within the past 6 months Uncontrolled angina Severe uncontrolled ventricular or other cardiac arrhythmias Acute ischemia or active conduction system abnormalities by ECG Serious psychiatric or medical illness, that would interfere with study compliance Social situations that would interfere with study compliance Acute active HIV-associated opportunistic infection requiring antibiotic treatment Mycobacterium avium or candidiasis allowed unless concurrent therapy with moderate-to-strong CYP3A4 inducers or inhibitors is required Chronic myelosuppressive agent therapy allowed provided hematologic criteria are met Hypersensitivity to compounds of similar chemical or biological composition to bortezomib, boron, mannitol, ifosfamide, carboplatin, or etoposide Concurrent malignancy except carcinoma in situ of the cervix, in situ anal cancer, nonmetastatic nonmelanoma skin cancer, or Kaposi's sarcoma not requiring systemic chemotherapy Active hepatitis B infection (hepatitis B surface antigen-positive), unless 1 of the following criteria are met: Able to start dual anti-hepatitis B adefovir and telbivudine therapy prior to study Receiving dual anti-hepatitis B therapy for at least 12 weeks prior to study with either agent active against HIV (i.e., entecavir, tenofovir, lamivudine, or emtricitabine) Concurrent grapefruit juice/fruit or green tea PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from prior adverse effects due to agents administered more than 3 weeks earlier Glucocorticoid therapy within the past 3 weeks allowed More than 3 weeks since prior chemotherapy More than 2 weeks since prior radiotherapy More than 14 days since prior and no other concurrent investigational agents (other than bortezomib) No concurrent moderate-to-strong CYP3A4 inducers or inhibitors other than protease inhibitors Concurrent stable (at least 12 weeks) antiretroviral regimen allowed

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Erin G. Reid, MD

Organizational Affiliation

University of California, San Diego

Official's Role

Study Chair

First Name & Middle Initial & Last Name & Degree

William Wachsman, MD

Organizational Affiliation

University of California, San Diego

Official's Role

Principal Investigator

Facility Information:

Facility Name

Rebecca and John Moores UCSD Cancer Center

City

La Jolla

State/Province

California

ZIP/Postal Code

92093-0658

Country

United States

Facility Name

USC/Norris Comprehensive Cancer Center and Hospital

City

Los Angeles

State/Province

California

ZIP/Postal Code

90089-9181

Country

United States

Facility Name

UCLA Clinical AIDS Research and Education (CARE) Center

City

Los Angeles

State/Province

California

ZIP/Postal Code

90095-1793

Country

United States

Facility Name

University of California at Davis Center for Aids Research and Education Services

City

Sacramento

State/Province

California

ZIP/Postal Code

95814

Country

United States

Facility Name

University of Miami Sylvester Comprehensive Cancer Center - Miami

City

Miami

State/Province

Florida

ZIP/Postal Code

33136

Country

United States

Facility Name

Emory Winship Cancer Institute

City

Atlanta

State/Province

Georgia

ZIP/Postal Code

30322

Country

United States

Facility Name

Cancer Research Center of Hawaii

City

Honolulu

State/Province

Hawaii

ZIP/Postal Code

96813

Country

United States

Facility Name

Northwestern Cancer Center

City

Chicago

State/Province

Illinois

ZIP/Postal Code

60611

Country

United States

Facility Name

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

City

Baltimore

State/Province

Maryland

ZIP/Postal Code

21231-2410

Country

United States

Facility Name

Beth Israel Deaconess Medical Center

City

Boston

State/Province

Massachusetts

ZIP/Postal Code

02215

Country

United States

Facility Name

Montefiore Medical Center

City

Bronx

State/Province

New York

ZIP/Postal Code

10467-2490

Country

United States

Facility Name

Memorial Sloan-Kettering Cancer Center

City

New York

State/Province

New York

ZIP/Postal Code

10065

Country

United States

Facility Name

Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center

City

Columbus

State/Province

Ohio

ZIP/Postal Code

43210-1240

Country

United States

Facility Name

Pennsylvania Oncology Hematology Associates, Incorporated - Philadelphia

City

Philadelphia

State/Province

Pennsylvania

ZIP/Postal Code

19106

Country

United States

Facility Name

Thomas Street Health Center

City

Houston

State/Province

Texas

ZIP/Postal Code

77009

Country

United States

Facility Name

Baylor College of Medicine

City

Houston

State/Province

Texas

ZIP/Postal Code

77030-2707

Country

United States

Facility Name

Virginia Mason Medical Center

City

Seattle

State/Province

Washington

ZIP/Postal Code

98101

Country

United States

12. IPD Sharing Statement

Citations:

PubMed Identifier

30573564

Citation

Reid EG, Looney D, Maldarelli F, Noy A, Henry D, Aboulafia D, Ramos JC, Sparano J, Ambinder RF, Lee J, Cesarman E, Yahyaei S, Mitsuyasu R, Wachsman W; AIDS Malignancy Consortium. Safety and efficacy of an oncolytic viral strategy using bortezomib with ICE/R in relapsed/refractory HIV-positive lymphomas. Blood Adv. 2018 Dec 26;2(24):3618-3626. doi: 10.1182/bloodadvances.2018022095.

Results Reference

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Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma

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