HIV-associated (AIDS-related) lymphomas: the decisions you may face

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Rituximab, Cyclophosphamide, Doxorubicin and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Rituximab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: B-Cell Lymphomas (AIDS-related B-cell lymphomas); AMC 034 (Blood 2010)), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (hiv-associated dlbcl), which of the standard options do you recommend and why?
   Why: Guideline options include: R-CHOP or dose-adjusted EPOCH-R at full dose with concurrent antiretroviral therapy (avoiding boosted protease inhibitors or cobicistat where possible), G-CSF support and opportunistic-infection prophylaxis; CNS prophylaxis by risk.
7. Am I a candidate for Rituximab, Cyclophosphamide, Doxorubicin or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Rituximab, Methotrexate, Cyclophosphamide and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Rituximab are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. Does your recommendation follow the current guideline (NCCN Guidelines: B-Cell Lymphomas), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
6. For my situation (hiv-associated burkitt lymphoma), which of the standard options do you recommend and why?
   Why: Guideline options include: Intensive Burkitt regimens (CODOX-M/IVAC with rituximab) in fit patients, or DA-EPOCH-R (low-intensity variant studied in HIV); intrathecal prophylaxis.
7. Am I a candidate for Rituximab, Methotrexate, Cyclophosphamide or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Bortezomib, Daratumumab, Pomalidomide and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. For my situation (primary effusion and plasmablastic lymphoma), which of the standard options do you recommend and why?
   Why: Guideline options include: CHOP or EPOCH-based chemotherapy with antiretroviral therapy; bortezomib-containing regimens for plasmablastic; clinical trials (pomalidomide, daratumumab, anti-IL-6).
5. Am I a candidate for Bortezomib, Daratumumab, Pomalidomide or related drugs, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

• BMT CTN 0803Phase 2NCT01141712201643 peopleevidence 63
  Tests Autologous stem cell transplant (high-dose therapy)
  HIV-infected patients over 15 with chemotherapy-sensitive relapsed or persistent aggressive B-cell lymphoma or Hodgkin lymphoma and treatable HIV: high-dose carmustine, etoposide, cytarabine and melphalan (BEAM) with autologous stem cell transplant and consistent peri-transplant antiretroviral management
  ▸Show survival figures (1)

  Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • One-year overall survival 87.3 percent and two-year overall survival 82 percent after autologous transplant, with two-year progression-free survival 79.8 percent and one-year transplant-related mortality 5.2 percent, no different from matched HIV-negative controls.
  Overall survival at 1 year (%): BEAM and autologous transplant in HIV-infected patients 87.3 (n=40) · source

1. Between Autologous stem cell transplant (high-dose therapy), Axicabtagene ciloleucel, CAR-T cell therapy and the other options, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. How closely do I match the people in BMT CTN 0803, and does that change what the results mean for me?
   Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. For my situation (relapsed or refractory), which of the standard options do you recommend and why?
   Why: Guideline options include: Salvage chemotherapy and autologous transplant (feasible with controlled HIV; BMT CTN 0803); CD19 CAR-T on the same criteria as HIV-negative patients; bispecific antibodies emerging.
6. Am I a candidate for Axicabtagene ciloleucel, Glofitamab, Epcoritamab, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
7. How do the results of BMT CTN 0803 apply to someone like me?
   Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Brentuximab vedotin, Doxorubicin and Bleomycin, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. Which side effects of Brentuximab vedotin are most likely for me, which are reversible, and which would make us stop?
   Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
4. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
5. For my situation (hiv-associated hodgkin lymphoma), which of the standard options do you recommend and why?
   Why: Guideline options include: ABVD or brentuximab-based regimens as for the general population, with antiretroviral therapy.
6. Am I a candidate for Brentuximab vedotin, Doxorubicin, Bleomycin, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.