Inmune Reconstitution After Autologous Stem Cell Trasplantation: Is There Any Difference Between HIV+ and HIV- Patients?

Little is known about immune reconstitution (IR) of HIV+ adult patients treated with HAART and high-dose chemotherapy followed by autologous stem cell transplantation (ASCT).

To compare the IR in HIV+ and HIV- patients treated with ASCT, and to correlate it with clinical outcome.

From January 2007 to January 2011 all HIV+ patients with lymphoma or multiple myeloma treated with ASCT where prospectively included. HIV- patients with lymphoma or multiple myeloma treated with ASCT were included as control. IR lymphocytes (Ly) subsets in peripheral blood were quantified by flow cytometry (FACScan, Becton-Dickinson Immunocytometry Systems, San Jose, CA). Naïve ly, memory ly, memory-activated ly, effector ly, NK cytotoxic ly, B naïve ly and B memory ly were quantified at the time of transplantation as well as at 3, 6, 12 and 18 months after ASCT. Additionally, immunoglobulin value, neutrophil and platelet engraftment (>0.5×10⁹/L and >20×10⁹/L respectively) and infectious complications were recorded in both groups. The study was approved by the local Ethics Committee.

We included 14 patients, 6 HIV+ and 8 HIV-. All this patients were in complete remission at the time of the ASCT. All patients received BEAM conditioning regimen, except for Melphalan 200 in the case of MM. The median infused CD34 was 4,08×10e6 in HIV+ patients and 5.2 x10e6 in control patients. All HIV+ patients had undetectable viral load at the time of the ASCT. Values of ly populations are shown in Table 1. Median neutrophils days of engraftment: 11.5 days (11–13.75) in HIV- and 14 in HIV+ (12.75–17), platelets: 15 (13–28) and 30 (17–78) (p:≤0.05) respectively. Both groups reached IR at third month, while HIV+ group showed lower values especially for the T CD4 ly subgroup (not statistically significant). HIV+ patients had statistically significant lower values of CD4 memory ly and activated CD4 ly at 6^th month, and lower values of NK ly at 3th month. On the other hand, we found lower values of B naïve Ly in HIV- patients at 6^th month. There was no difference in the median value of immunoglobulin at 3, 6 and 12 months between both groups. Infections were more frequents in HIV+ patients: positive Aspergillus antigenemia (3/6 vs. 1/8), positive CMV antigenemia (3/6 vs. 1/6), fungal infection (2/6 vs. 0/8) and bacterial infections (5/ 6 vs. 2/8), nevertheless severe episodes didn't shown differences, as well as disease free survival and mortality.

In this series, IR was reached at the third month in both HIV + and HIV- patients, with non-significant lower values for HIV+ patients. Despite infections were more frequent in HIV+ patients, this was not associated with a higher mortality.

Median values of lymphocytes population studied. Yellow box remarked corresponds

To the statistically significant results (p:≤0,05)

No relevant conflicts of interest to declare.