Historically, prognoses have been poor for patients diagnosed with HIV-associated lymphoma (HAL); however, highly active antiretroviral therapy has increased these patients’ ability to tolerate standard of care and has led to significantly improved outcomes.
Within the last decade, HAL patients have received comparable therapies to those offered to other lymphoma patients. However, because HAL patients are immunocompromised, they have been considered to be ineligible for stem cell transplantation, regarded as the standard of care for relapsed or treatment-resistant disease.
As a result, HAL patients remain at a significant treatment disadvantage.
To examine whether transplant could be a safe and effective approach for HAL patients, researchers from the National Cancer Institute Bone Marrow Transplant Clinical Trials Network working in collaboration with the AIDS Malignancy Consortium, conducted a large, multi-center study among 40 patients with controlled HIV infection receiving autologous stem cell transplants with a high-dose preparative regimen.
Patients had persistent or recurrent Hodgkin or aggressive non-Hodgkin lymphoma. At 100 days post-transplant, 36 patients (92.3%) had achieved complete response, one (2.6%) reached partial remission, and two (5.1%) had relapsed. One patient had died.
Within a year after transplant, 17 patients (42.5%) developed a total of 42 unique infections. Nine of 17 patients developed severe infection. After a median two-year follow-up, the one-year survival among the transplanted patients was 86.6 percent. The cumulative incidence of transplant-related mortality was 5.2 percent.
“These impressive survival data demonstrate that autologous stem cell transplants can be highly effective, tolerable, and not overly toxic for patients with HIV-associated lymphoma,” said lead study author Joe Alvarnas, MD, of City of Hope National Medical Center in Duarte, CA.
“Ultimately, our results provide a persuasive argument that HIV or AIDS status should not be a barrier to autologous stem cell transplant for patients who meet standard eligibility criteria.”