Hematopoietic Cell Transplant Safe in HIV-Related Lymphoma

SAN FRANCISCO-Autologous hematopoietic cell transplantation is a safe and effective treatment option for patients with HIV-associated lymphoma, according to the results of trial presented here by Joseph Alvarnas, MD, of City of Hope National Medical Center.

Patients with HIV-related lymphoma who underwent transplant in the clinical trial had an estimated 1-year overall survival probability of 86.6%, with a cumulative risk for relapse or progression at 1-year of 12.5%.

Although patients with HIV have an estimated 25-fold increased risk for Hodgkin lymphoma and non-Hodgkin lymphoma, according to Alvarnas, HIV infection remains an exclusion criterion for most autologous hematopoietic cell transplantation in clinical trials. When transplant does occur in clinical practice, they still remain limited to centers with HIV-specific expertise.

In this trial, Alvarnas and colleagues enrolled 43 patients aged older than 15 years to undergo autologous hematopoietic cell transplant. Three patients did not undergo transplant due to disease progression. Pre-transplant HIV viral load was undetectable in 77.5% of patients. Patients underwent transplant using the BEAM regimen and received standard supportive care through discharge.

At day 100 post-transplant, 39 patients were evaluated for response and the researchers found that 92.3% of patients were in complete remission and one in partial remission. By 1-year post-transplant, five patients had relapsed/progressive disease, three of whom subsequently died of persistent recurrent disease. Within a year of transplant, 17 patients (42.5%) developed 42 unique infections; 9 of these patients developed severe infections.

The progression-free survival among patients at 1-year is projected to be 82.3% (95% CI, 66.3%–91.1%), Alvarnas said.

In order to see how these results compared to non-HIV-infected patients, the researchers formed a case matched control between 151 control patients identified from the Centers for International Bone Marrow Transplant Research database. Patients were matched for age, performance status, disease, and disease stage.

“The overall mortality, treatment failure, progression, and mortality between groups were not statistically significantly different,” Alvarnas said. “When you look at overall survival in comparison between these two groups there is no significant difference between offering this type of transplant to our HIV-infected patients and those matched controls.”

Based on the results of this study, Alvarnas said that patients with treatment-responsive HIV infection and HIV-related lymphoma should be considered candidates for autologous hematopoietic cell transplant if they meet standard transplant criteria.

“Exclusion from clinical trials on the basis of HIV infection alone is no longer justified,” he said.