Abstract

Several authors have reported ASCT as a feasible, safe and effective treatment in HIV associated lymphoma patients (pts) receiving Highly Active Antiretroviral Therapy (HAART), particularly when being autografted with chemosensitive disease. To gain a better understanding of the usefulness of ASCT in HIV+ Lymphoma pts a retrospective comparative study (HIV+ vs HIV- lymphoma pts with ASCT) has been performed using the EBMT-LWP Registry. Methodology: Registry-based, retrospective, individually matched case-control analysis. Within the participating centres one or two HIV- controls for each HIV+ pt were selected from the registry with the following inclusion criteria: Known HIV serological status at ASCT, lymphoma (HL or NHL), ASCT performed between 1999 and 2006 and pts over 18 years of age. Two cohorts (HIV+ vs HIV-) were matched for histology, IPI at diagnosis (NHL), stage at diagnosis, disease status at ASCT, age at ASCT, year and country of ASCT. Results: 40 HIV+ lymphoma pts undergoing an ASCT were matched with 46 HIV- pts. Pts and transplant features are shown in table 1. With a median follow up of 36 mo, the differences regarding OS and PFS were not significant: 62% for HIV+ vs 69% for controls, and 56.5 vs 58%, respectively. No differences were seen regarding HL and NHL pts. An overall TRM of 10% was observed in the HIV cohort, mainly related to infections, while no cases of TRM were seen within the control arm. Since survival rates between the HIV+ and the matched HIV- lymphoma populations remained comparable, the HIV condition should not preclude these pts from being treated according to the same criteria as the HIV negative lymphoma population. Nevertheless, infectious complications should be cautiously followed within the HIV+ lymphoma pts undergoing an ASCT.

Patients and transplant features

HIV+HIV-
n=40%n=46%
Age [Median (range)] in years41.4 (29.2–62.5)44 (16–62.4)p= NS
Male sex 35 87.5 25 54.3 p=0.001 
Histology 
    DLBCL 24 60 25 54.3 p= NS 
    Burkitt lymphoma 4.3 p= NS 
    T-cell NHL 6.6 p= NS 
    HL 12 30 16 34.8 p= NS 
Disease status at ASCT 
    Complete remission (CR) 21 (12 in CR1) 52.5 (30 in CR1) 20 (11 in CR1) 43.5 (24 in CR1) p= NS 
    Chemosensitive disease 16 40 25 54.3 p= NS 
    Chemorefractory disease 7.5 2.2 p= NS 
CD34+ cells infused mill/kg [median (range)] 4.9 (1.6–21.2) 4.8 (0.9–21.2) p= NS 
    G-CSF prior to engraftment 36 90 21 46 p= 0.0001 
    Neutrophil engraftment 39 98% 46 100 p= NS 
Cause of Death 
    Relapse/progression 60% 10 84% p=0.08 
    Secondary malignancy 6.7% 8% p= NS 
    Transplant-related deaths 26.7% 0% p=0.06 
    Other 6.7% 8% p= NS 
HIV+HIV-
n=40%n=46%
Age [Median (range)] in years41.4 (29.2–62.5)44 (16–62.4)p= NS
Male sex 35 87.5 25 54.3 p=0.001 
Histology 
    DLBCL 24 60 25 54.3 p= NS 
    Burkitt lymphoma 4.3 p= NS 
    T-cell NHL 6.6 p= NS 
    HL 12 30 16 34.8 p= NS 
Disease status at ASCT 
    Complete remission (CR) 21 (12 in CR1) 52.5 (30 in CR1) 20 (11 in CR1) 43.5 (24 in CR1) p= NS 
    Chemosensitive disease 16 40 25 54.3 p= NS 
    Chemorefractory disease 7.5 2.2 p= NS 
CD34+ cells infused mill/kg [median (range)] 4.9 (1.6–21.2) 4.8 (0.9–21.2) p= NS 
    G-CSF prior to engraftment 36 90 21 46 p= 0.0001 
    Neutrophil engraftment 39 98% 46 100 p= NS 
Cause of Death 
    Relapse/progression 60% 10 84% p=0.08 
    Secondary malignancy 6.7% 8% p= NS 
    Transplant-related deaths 26.7% 0% p=0.06 
    Other 6.7% 8% p= NS 

Author notes

Disclosure: Research Funding: This research has been partially supported by grant BA05/90038 from the Ministerio de Sanidad y Consumo, Spain.