HIV Status Does Not Affect the Outcome of Autologous Stem Cell Transplantation (ASCT) for Non-Hodgkin Lymphoma (NHL)

Abstract

Purpose Randomized trials comparing autologous stem cell transplant (ASCT) to conventional chemotherapy have demonstrated superior survival among HIV negative ASCT patients with relapsed non-Hodgkin lymphoma (NHL). Recent trials explored the feasibility of ASCT in the HIV setting. While these studies have shown that ASCT in HIV positive NHL patients (HIVpos-NHL) is well tolerated, the impact of HIV infection on long-term transplant outcome is not well characterized. Ongoing comparison of long-term survival following ASCT in HIVpos-NHL patients and HIVneg-NHL patients will allow investigators to explore whether there should be inclusion of HIVpos-NHL patients in ASCT trials. Patients and Methods To study long-term outcome we conducted a single institution matched case-control study in HIVpos-NHL patients (cases) and HIVneg-NHL patients (controls). Twenty-nine patients with HIVpos-NHL were matched with HIVneg-NHL controls on gender, time to ASCT, year of transplant, histology, age, disease status, number prior regimens, and conditioning regimen. Results Non-relapse mortality was similar: 11% (95%CI: 4–28%) in HIVpos-NHL patients and 4% (95%CI: 1–25%) in HIVneg-NHL controls (p=0.18). Two year DFS for the HIVpos-NHL patients was 76% (95%CI: 62–85%) and 56% (95%CI: 45–66%) for the HIVneg-NHL controls (p=0.33). OS was also similar; the two-year point estimates were 75% (95%CI: 61–85%) and 75% (95%CI: 60–85%) respectively (p=0.93), despite inclusion of more poor risk HIVpos-NHL patients. Conclusion These results provide further evidence that HIV status does not affect the long-term outcome of ASCT for NHL and therefore HIV status alone should no longer exclude these patients from transplant clinical trials.

Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the BMT CTN 0803/AMC 071 trial

“…This is consistent with the finding of prior case-control studies demonstrating similar outcomes for AHCT in HIV-infected vs HIVuninfected patients. 30,41 Together, these trials validate the concept that controlled HIV infection should not preclude consideration of AHCT for patients who otherwise meet standard transplant eligibility criteria. The non-HIV-related inclusion and exclusion criteria for this trial were adapted from those used in the previous BMT CTN 0401 trial, a study that was designed for a non-HIV-infected population.…”

Hematopoietic stem cell transplantation for HIV cure

“…Whereas earlier efforts were complicated by limited BM reserve and overall poor state of health of patients with advanced HIV disease, as well as synergistic toxicities due to the myelosuppressive effects of zidovudine (15,16), the development of more potent and better tolerated ART regimens with fewer side effects allowed HIV-infected patients with leukemias or lymphomas to receive aggressive antineoplastic therapy, along with autologous or allogeneic HSCT (17)(18)(19)(20)(21). By the end of the first decade of the 2000s, the outcome of autologous HSCT in HIV-infected patients with lymphoma approached that in HIV-uninfected patients (22) and had become a standard of care (22)(23)(24)(25).…”

HIV and Lymphoma

“…Similarly, in a single institution analysis Krishnan et al ( 2010 ) compared 29 patients with HIV-positive NHL matched with HIV-negative-NHL patients. The non-relapse mortality was similar in HIV-positive-NHL (11%) and HIV-negative-NHL (4%) with a p = .18.…”