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PURPOSE Africa is burdened by the AIDS epidemic and attendant increase in HIV/AIDS-related malignancies. Pragmatic approaches to therapeutic intervention could be of great value. Dose-modified oral chemotherapy for AIDS-related non-Hodgkin's lymphoma is one such approach. PATIENTS AND METHODS The oral regimen consisted of lomustine 50 mg/m(2) on day 1 (cycle 1 only), etoposide 100 mg/m(2) on days 1 to 3, and cyclophosphamide/procarbazine 50 mg/m(2) each on days 22 to 26 at 6-week intervals (one cycle) for two total cycles in HIV-infected patients with biopsy-proven non-Hodgkin's lymphoma. Results Forty-nine patients (21 in Uganda and 28 in Kenya) were treated. The majority of patients were female (59%) and had a poor performance status (63%); 69% of patients had advanced-stage disease; and 18 patients (37%) had access to antiretroviral therapy. In total, 79.5 cycles of therapy were administered. The regimen was well tolerated, had modest effects (decline) on CD4(+) lymphocyte counts (P = .077), and had negligible effects on HIV-1 viral replication. Four febrile neutropenia episodes and three treatment-related deaths (6% mortality rate) occurred. The overall objective response rate was 78% (95% CI, 62% to 88%); median follow-up time was 8.2 months (range, 0.1 to 71 months); median event-free and overall survival times were 7.9 months (95% CI, 3.3 to 13.0 months) and 12.3 months (95% CI, 4.9 to 32.4 months), respectively; and 33% of patients survived 5 years. CONCLUSION Dose-modified oral chemotherapy is efficacious, has comparable outcome to that in the United States in the pre-highly active antiretroviral therapy setting, has an acceptable safety profile, and is pragmatic in sub-Saharan Africa. The international collaboration has been highly successful, and subsequent projects should focus on strategies to optimize combination antiretroviral therapy and chemotherapy and follow-up tissue correlative studies.

Between 1967 and 1977, 48 patients with Hodgkin's disease under 16-years-old were treated with MOPP chemotherapy alone at the Uganda Cancer Institute because radiotherapy facilities are not available. Thirty-eight percent had early stage disease (stages I-IIIA). Prolonged first remissions were achieved in 74% of 42 complete responders. Of 11 patients who relapsed, 5 had prolonged second remissions induced by MOPP. Three patients were lost to follow-up and 15 of the remaining 45 died: 12 of these from progressive Hodgkin's disease, 2 from unrelated causes and 1 from Burkitt's lymphoma after 4 months remission from Hodgkin's disease. Acturial survival for all patients is 67% (75% for stages I-IIIA and 60% for stages IIIB-IV). Treatment complications included Herpes zoster and gynaecomastia. The latter is probably related to gonadal dysfunction. All stages of childhood Hodgkin's disease can be successfully managed with MOPP chemotherapy alone.