Autologous Stem Cell Transplant Safe as Standard of Care in Patients With HIV-Associated Lymphoma
Magnified stem cells
Recent results from a multicenter, phase 2 trial suggest that patients with HIV and aggressive lymphoma should receive autologous stem cell transplant as standard of care. Risk of serious complications after undergoing autologous stem cell transplant in these patients is equal to that of patients who are not HIV infected.1
"Overall survival for patients with HIV infection after transplant is comparable to that seen in people who were not HIV-infected," said Joseph Alvarnas, MD, associate clinical professor in the department of hematology and director of value-based analytics at the City of Hope National Medical Center, Duarte, California, and lead author of the study.
In autologous hematopoietic cell transplant (AHCT), healthy cells from the patient's blood or bone marrow are collected and administered to aid recovery after high-dose chemotherapy. This procedure has become the standard of care for treating relapsed and refractory Hodgkin and non-Hodgkin lymphomas, yet its use in patients infected with HIV has been limited due to concerns over excessive toxicities or infections.
In this study, 43 patients with treatable HIV infection and chemotherapy-sensitive relapsed or refractory non-Hodgkin or Hodgkin lymphoma enrolled between April 2010 and March 2013. Of these patients, 40 underwent AHCT at 16 centers. Three patients did not undergo AHCT due to disease progression.
Clinicians assessed disease status before AHCT, at day 100, and at 1 year after AHCT. The group of patients with HIV was compared to data from a group of 151 patients without HIV but with relapsed or refractory lymphoma. This group of 151 patients also underwent AHCT.
Median follow-up was 25 months. Overall survival (OS) of the group with HIV was 87.3% at 1 year and 82% at 2 years after AHCT. The OS of the non-HIV group was 87.7% at 1 year, which is similar to the HIV group.
The probability of 2-year progression-free survival in the group with HIV was 79.8%. Recurrence or persistence of lymphoma, fungal infection, and cardiac arrest resulted in a 1-year transplant-related death of 5.2%, also similar to the non-HIV group.
Most patients (82%) had undetectable levels of the virus after 1 year, suggesting patients with HIV maintained good control over the infection after AHCT. Median time to white blood cell recovery was 11 days, and median time to platelet recovery was 18 days. Within the first year after AHCT, 15 patients experienced severe toxicities, and 17 patients developed at least 1 infection.
"These findings are remarkably important for a group of patients who, up until now, have been inconsistently treated," Alvarnas said.
"Transplantation allows clinicians to treat the cancer most effectively by using more intense doses of chemotherapy than can typically be given, while avoiding fears of wiping out the bone marrow. Based on our data, autologous stem cell transplant should be considered the standard of care for patients with HIV-related lymphomas for the same indications and under the same circumstances that we would use it in patients without HIV infection."
1. Alvarnas JC, Le Rademacher J, Wang Y, et al. Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the (BMT CTN) 0803/(AMC) 071 Trial [published online June 13, 2016]. Blood. doi:10.1182/blood-2015-08-664706.