Autologous stem cell transplantation for HIV-associated lymphoma.
Is peripheral stem cell mobilization followed by autologous stem cell transplantation (ASCT) feasible in patients with human immunodeficiency virus (HIV)- associated lymphoma (HIV-L)? Studies have demonstrated that, in the HIV- negative (HIV(-)) setting, ASCT may improve lymphoma-free survival in high-risk non-Hodgkin lymphoma (NHL) or relapsed Hodgkin disease (HD) and NHL. Given the poor prognosis of HIV-L with conventional chemotherapy, this dose-intensive approach was explored. Nine patients with HIV-HD or NHL mobilized a median of 10.6 x 10(6) CD34(+) cells/kg and engrafted after ASCT. CD4 counts recovered to pretransplantation levels and HIV viral loads were controlled in patients compliant with antiretroviral therapy. Seven of 9 patients remain in remission from their lymphoma at a median of 19 months after transplantation. Thus, patients with HIV-L on antiretroviral therapy can engraft following ASCT. Prolonged lymphoma remissions, without significant compromise of immune function, can be seen, suggesting that ASCT can be used in selected patients with HIV-L.
Krishnan
A
A
Division of Hematology and Bone Marrow Transplantation, City of Hope Medical Center, Duarte, California 91010, USA. akrishnan@coh.org
Molina
A
A
Zaia
J
J
Nademanee
A
A
Kogut
N
N
Rosenthal
J
J
Woo
D
D
Forman
S J
SJ
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000150:complications; D018791:CD4 Lymphocyte Count; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D009894:Opportunistic Infections / Q000150:complications; D011379:Prognosis; D012074:Remission Induction; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous