AHCT Safe, Effective Option for Patients With HIV-Associated Lymphoma

Patients with HIV-related lymphoma (HRL) who underwent autologous hematopoietic cell transplant (AHCT) had good survival at 1 year, with outcomes and adverse events similar to those seen in patients without HIV undergoing this treatment, according to a phase II study published in Blood.

“The availability of effective anti-HIV therapy has altered our previous understanding of the best management for patients with HRL and has allowed these patients to benefit from standard chemotherapeutic regimens,” wrote researchers led by Joseph C. Alvarnas, MD, of City of Hope National Medical Center. “This trial builds on a body of previously published data to demonstrate clearly that HIV infection alone should not be considered a contraindication to AHCT for patients who otherwise meet transplant inclusion criteria.”

The BMT CTN 0803/AMC 071 trial enrolled 43 patients with HRL. Patients were aged older than 15 years and had treatable HIV infection. The patients were prepared for transplant with carmustine, etoposide, cytarabine, and melphalan and received consistent management of peri-transplant antiretroviral treatment. Forty patients were able to undergo transplant. HIV viral load was undetectable in 80% of patients.

With a median follow-up of longer than 2 years, the 1-year overall survival probability was 87.3% and the 2-year survival probability was 82%. Seven patients died, including five who died within 1 year of transplant. At the time of transplant, 75% of patients were in complete remission and 22.5% were in partial remission. The probability of 2-year progression-free survival was 79.8%. At 1 year, the transplant-related mortality was 5.2%.

Looking at post-transplant recovery, the researchers found a median time of post-transplant neutrophil recovery of 11 days and the median time to platelet recovery was 18 days.

Grade 3–5 adverse events occurred in nine patients. Ten grade 3 events and three grade 4 events occurred, including infection/sepsis, venous thromboembolism, esophageal candidiasis, enteritis, hyperglycemia, hypernatremia, acute appendicitis, and acute coronary syndrome.

At 1 year post-transplant, the median CD4+ T-cell count was 280.3/μL, and 82.6% of patients had an undetectable viral load.

“The median CD4+ T-cell counts returned to pre-transplant levels by the day + 60 analysis window and were maintained through day + 365,” the researchers wrote. “These data demonstrate that there does not appear to be any long-term loss of CD4+ T-cells following AHCT and that significant, long-term worsening of T-cell immunity is not a complication of transplant.”

Alvarnas and colleagues then compared patients in this trial with 151 matched patients from the Center for International Bone Marrow Transplant Research database. They found that outcomes for the control patients were similar to those in the patients with HRL. The probability of 1-year survival in this control group was 87.7% (compared with 87.3% in HRL) and the probability of progression-free survival was 69.5% (compared with 79.8% in HRL).

“AHCT should be considered the standard of care for patients with HRL, provided that the HIV infection is treatment-responsive,” the researchers wrote. “Patients with HRL should also be considered appropriate potential participants for future AHCT clinic trials.”