Autologous Stem Cell Transplantation (ASCT) in HIV Associated Lymphoma (HIV-Ly) Patients: The EBMT Lymphoma Working Party (EBMT-LWP) Experience.

Following the widespread use of Highly Active Antiretroviral Therapy (HAART), ASCT has been reported as a feasible and effective treatment in the setting of HIV-Ly patients (pts). Nevertheless just series including up to 20 patients have been published so far. We present a preliminary analysis of the outcomes regarding the experience within the EBMT-LWP.

Methodology: A retrospective analysis including HIV-Ly patients undergoing peripheral blood ASCT from 1999 to 2005 and reported to the EBMT was performed. Main endpoints: OS, EFS and TRM.

Results: 44 pts from 14 institutions/7 countries were included: 39 males, median age 43 (29–62) years old. One pt underwent more than 1 ASCT (follow up censored at time of 2^nd ASCT). In addition to HIV infection, 11 pts were co-infected by HBV, 8/43 by HCV and 16/36 pt met AIDS criteria (other than lymphoma) at the time of lymphoma diagnosis.

Histology: 34 NHL (20 DLBCL; 7 Burkitt/Burkitt-like; 4 plasmablastic; 3 other), 59% of them with IPI>2 at diagnosis; 10 HL (50% with Ann-Arbor stage>IIB at diagnosis). Patients received a median of 2 (1–5) treatment lines pre-ASCT. Status at ASCT: 22 CR (13 in CR1); 18 in PR/chemo-sensitive relapse and 4 in primary induction failure/chemo-resistant relapse. Conditioning: 41 pts received BEAM/variants and 3 TBI-based regimens. Post-ASCT anti-tumour pre-emptive treatment was used in 10 pts (8 radiotherapy; 2 Rituximab). The median count of T-CD4+ cells/μl was 162 (8–702) at the time of ASCT; 26/38 had undetectable HIV viral loads. HAART was given in 39/42 pts during conditioning but was withdrawn in 9 of them. The median number of CD34+ cells infused was 5 (1,6–21,2) x10⁶/kg. G-CSF was used until engraftment in 39/43 pt during a median of 8 (2–29) days. All pts but one who died on day +15 reached neutrophils>500/μl at a median time of 11 (8–36) days. Platelet count >20.000/μl was reached in 39/44 pt at a median time of 14 (6–455) days. The pt engrafting platelets on day +455 was transfusion independent since day +49. Three new post-ASCT malignancies were reported: in situ epitelioma and myelodysplasia (+4 years) in 1 pt, and kidney adenocarcinoma (+3 years) in another one. Relapse occurred in 13 (29,5%) pts which status at SCT was CR in 4, PR/chemosensitive relapse in 5 and chemo-resistant disease in 4. The median time to relapse/progression was 5,2 (0,6–32,1) mo. Seventeen pts died (38,6%): disease relapse/progression (n=11), ASCT-related complication (n=4) -bacterial infection (n=3), secondary myelodysplasia (n=1)-, 1 pt died from an HIV-related complication and 1 pt died on day +15 of multi-organ failure within the context of a bacterial sepsis and pre-transplant renal dysfunction. With a median follow up time of 36,3 (3,2–72,3) mo, the OS and DFS probability at this point were 60,2% (67,5% when chemo-resistant pts were excluded from analysis) and 55% respectively. For those pts in CR1 at ASCT, OS at 36,3 mo was 85% vs 60% for those in CR>1/PR/chemosensitive relapse.

Conclusion: The results from the EBMT-LWP experience, the largest reported so far, show that ASCT remains a useful treatment in terms of TRM, long-term OS, and DFS for high risk HIV-Ly patients. These outcomes are comparable to those observed in HIV negative lymphoma patients.