Durable remissions with autologous stem cell transplantation for high-risk HIV-associated lymphomas

The treatment of HIV-associated lymphoma has changed since the widespread use of highly active antiretroviral therapy. HIV-infected individuals can tolerate more intensive chemotherapy, as they have better hematologic reserves and fewer infections. This has led to higher response rates in patients w...

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Bibliographic Details
Published in:Blood 2005-01, Vol.105 (2), p.874-878
Main Authors: Krishnan, Amrita, Molina, Arturo, Zaia, John, Smith, David, Vasquez, Debbie, Kogut, Neil, Falk, Peter M., Rosenthal, Joseph, Alvarnas, Joseph, Forman, Stephen J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
CD4 Lymphocyte Count
Child
Disease-Free Survival
Follow-Up Studies
Hematologic and hematopoietic diseases
Human viral diseases
Humans
Infectious diseases
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lymphoma, AIDS-Related - epidemiology
Lymphoma, AIDS-Related - therapy
Medical sciences
Middle Aged
Recurrence
Remission Induction
Risk Factors
Stem Cell Transplantation
Transplantation, Autologous
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:The treatment of HIV-associated lymphoma has changed since the widespread use of highly active antiretroviral therapy. HIV-infected individuals can tolerate more intensive chemotherapy, as they have better hematologic reserves and fewer infections. This has led to higher response rates in patients with HIV-associated Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL) treated with chemotherapy in conjunction with antiretroviral therapy. However, for patients with refractory or relapsed disease, salvage chemotherapy still offers little chance of long-term survival. In the non-HIV setting, patients with relapsed Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL) have a better chance of long-term remission with high-dose chemotherapy with autologous stem cell rescue (ASCT) compared with conventional salvage chemotherapy. In a prior report we demonstrated that this approach is well tolerated in patients with underlying immunodeficiency from HIV infection. Furthermore, similar engraftment to the non-HIV setting and low infectious risks have been observed. Herein, we expand upon this early experience with the largest single institution series of 20 patients. With long-term follow-up we demonstrate that ASCT can lead to an 85% progression-free survival, which suggests that this approach may be potentially curative in select patients with relapsed HIV-associated HD or NHL.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2004-04-1532