Autologous Hematopoietic Stem Cell Transplantation Combined with High-Dose Chemotherapy As First-Line Treatment for HIV-Associated Lymphoma: A Retrospective Analysis

BACKRGOUND

At present, lymphoma is one of the three most common malignant tumors in AIDS patients. With the popularization of cART treatment, the incidence of AIDS-associated lymphoma has decreased, but it is still higher than that in the general population with poor prognosis. The Central and Western China AIDS Lymphoma League (CALL) is committed to investigate the efficacy and related factors of autologous hematopoietic stem cell transplantation (auto-HSCT) as consolidation therapy for newly diagnosed HIV-associated lymphoma.

METHODS

From 2018 to 2023, 11 newly diagnosed patients with AIDS-associated lymphoma in our center were collected, including 10 males and 1 female, 2 of whom received double ASCT, with a median age of 38 years (range 25-64 years). One case (11.1%) had bone marrow involvement, 3 cases (27.3%) had low/low-intermediate risk according to IPI, and 2 cases (63.6%) had high/intermediate risk according to IPI. Ten patients (90.9%) achieved complete remission (CR) and 1 patient (9.1%) achieved partial remission (PR) before transplantation.

RESULTS

Among the 11 patients, 2 patients (1 with high-risk diffuse large B cell lymphoma and 1 with plasmablastic lymphoma) received double transplantation within 6 months, and the remaining patients received single transplantation. The median CD34 collection before transplantation was 4.67 (2.5-12.52) *10^6/kg. 3 patients received BeEAC regimen, 7 patients received BeEAM regimen, and 1 patient received IAC regimen for the second transplantation. Five patients (45%) developed various degrees of infection during transplantation, which was improved after anti-infection treatment. All patients achieved hematopoietic reconstitution. The median time of neutrophil and platelet engraftment was 11.9 ± 2.23 days and 12.1 ± 2.96 days, respectively.

At a median follow-up of 12 (3-14) months after transplantation, 1 patient died within 100 days after transplantation, 1 patient died of Covid-19 virus infection, 1patient achieved PR, other 8 patients remained CR.. Patient no. 1 died from bacteremia 1 months after ASCT. Patient no. 8 relapsed 6 months after ASCT and died from Covid-19 virus infection when 5 months after ASCT. Patient no. 9 relapsed 6 months after ASCT, but is still alive in second CR and is receiving lenalidomide maintenance therapy. Other 8 patients in CR post-ASCT are receiving lenalidomide/Interferon/rituximab maintenance therapies. Therefore, overall survival for the 11 transplanted patients is 81% at 12 months, with a median follow-up of 12 months (range 5-60 months). Furthermore, eight patients remained in CR, for an progression-free survival of 72% at 12 months, with a

median follow-up of 19 months (range 9-60 months).It is worth mentioning that active HIV replication was not monitored with the continuous use of cART agents during lymphoma chemotherapy and ASCT; cART administration did not affect the number of harvested stem cells or the time to engraftment after transplantation.