Comparative Study of Autologous Stem Cell Transplant (ASCT) in HIV-1 Positive (HIV+) on Haart and HIV-1 Negative (HIV−) Non Hodgkin Lymphoma (NHL) Patients.
Authors: Serrano David , Balsalobre Pascual , Carrion Rafael , Anguita Javier , Miralles Pilar , Berenguer Juan , Buño Ismael , Gomez-Pineda Alfonso , Varela Rosario , Conde Eulogio , Espigado Ildefonso , Escola Lourdes , Fernandez Pascual , Sanchez-Godoy Pedro , Loscertales Javier , Ribera Josep-Maria , Diez-Martin Jose L. 
Published: October 2019

ASCT has been reported as a feasible, safe and effective treatment in HIV associated lymphoma patients (pts) receiving Highly Active Antiretroviral Therapy (HAART). For a better knowledge regarding the outcomes within this setting we have compared the clinical results of a multicentre cooperative cohort of auto-transplanted HIV+ NHL pts, with a matched cohort of HIV− NHL pts who underwent ASCT in our hospital.

Patients and Methods: 17 HIV+ NHL pt auto-transplanted since 2001 have been included, as well as a similar number of matched HIV− NHL pts. Both cohorts were comparable for the most relevant clinical features (p value Mann-Whitney test or chi-square test > 0.05) (see table). HAART was maintained during mobilization and ASCT. The median number of CD34+ cells infused was 3,73x106 CD34+ cells/kg in HIV+ pts and 4,75x106 CD34+ cells/kg in HIV− pts (p: NS). G-CSF was used in 16/17 HIV+ pts until engraftment starting at a median of 7 days (d) after ASCT.

Results: All but 1 HIV+ pt who died in relapse due to multiorgan failure on day +15 engrafted. The median time to engraftment was 12,5 (9–33) d in HIV+ pts, and 13 (9–18) d in HIV− pts. The incidence of acute infectious and toxic events was similar in both groups. All pts developed neutropenic fever. The documented infections were (HIV+ vs HIV−): Gram+ bacteriemia (5 vs 4), Gram- bacteriemia (1 vs 2), CMV antigenemia (1 vs 1). Aspergillus pneumonia was documented in one HIV+ pt and Candida parapsilosis was cultured in another HIV+ pt. One case of pneumonia ocurred in the HIV− group. Two toxic events were documented in the HIV+ group: 1 VOD and 1 multiorgan failure. All but one events (multiorgan failure) were succesfully resolved. The median time of follow up was 36,5 mo in HIV+ and 32,3 mo in HIV−. Within the HIV+ group 5 pt relapsed, 3 of them died and 2 remain in CR after rescue chemotherapy. Other 3 pts died (multiorgan failure, late HIV opportunistic infection and post-ASCT myelodysplasia). In the HIV− group 8 pts relapsed and all of them died. The median time to relapse/progression was 3,5 mo (HIV+) vs 3 mo (HIV−). The OS at 36 mo was (HIV+ vs HIV−) 67% vs 49% (p=NS) and EFS at 36 mo was 55% vs 52,3% (p=NS).

Conclusions: Our results show that the clinical outcomes in NHL HIV+ and NHL HIV− pt undergoing ASCT are comparable. Engraftment, infectious and toxic events as well as survival were not different. ASCT may be applied in HIV+ NHL on HAART pts with similar guarantees as in the HIV-negative setting.

Table: Clinical features of both series HIV+ NHL pt HIV− NHL pts Age 43 46 Adjusted IPI: >2 10 12 Status at ASCT: CR1 or PR 8 12 Pre-ASCT treatment lines: >1 12 13 HISTOLOGY Burkitt-Burkitt like 3 1 Peripheral T-cell 1 1 Anaplastic 2 1 DLBC 9 12 Plasmablastic 2 0 B or T Lymphoblastic 0 2 CONDITIONING BEAM/BEAC 16 11 TBI-based regimens 1 1 BuCy 0 4 CBV 0 1