High-dose therapy and autologous peripheral-blood stem-cell transplantation as salvage treatment for HIV-associated lymphoma in patients receiving highly active antiretroviral therapy.
OBJECTIVE
High-dose therapy (HDT) and peripheral-blood stem-cell transplantation (PBSCT) in HIV-associated lymphoma (HIV-Ly) has been recently reported in selected patients. We describe the results of a multi-institutional program of HDT and PBSCT as salvage therapy in HIV-Ly responsive to highly active antiretroviral therapy (HAART) in unselected patients.


METHODS
Patients with resistant or relapsed HIV-Ly after first-line chemotherapy (CT) underwent PBSC collection after a course of second-line CT or cyclophosphamide and granulocyte colony-stimulating factor. Patients with chemotherapy-sensitive disease received carmustine, etoposide, cytarabine, and melphalan (BEAM regimen) and PBSC reinfusion. Effective HAART was maintained during the entire program.


RESULTS
Sixteen consecutive patients entered the program. Adequate collection of PBSC was obtained in 80% of patients (median CD34+ cells 6.8 x 106/kg). Three patients had early progression. Ten patients (62%) received PBSCT with prompt engraftment in all patients (neutrophils and platelet engraftment after a median of 10 days [range, 8 to 10 days] and 13 days [range, 8 to 18 days], respectively). No patients died as a result of opportunistic or other infections or treatment-related complications. Eight of nine assessable patients achieved complete remission (one patient after radiotherapy for residual disease) and one patient achieved partial remission. Two patients experienced relapse and died at +10 and +14 months. Six patients are alive and disease free at a median of 8 months after transplantation.


CONCLUSIONS
Our data confirm that HDT plus PBSCT is feasible and active as salvage therapy in HIV-Ly on a multi-institutional basis and in unselected HAART-responding patients. HIV infection should no longer preclude the opportunity of HDT in patients with lymphoma.
Divisione di Ematologia, Spedali Civili, p.le Spedali Civili, 1, 25123 Brescia, Italy. reale@bshosp.osp.unibs.it
Alessandro
A
Re
Chiara
C
Cattaneo
Mariagrazia
M
Michieli
Salvatore
S
Casari
Michele
M
Spina
Maurizio
M
Rupolo
Bernardino
B
Allione
Annamaria
A
Nosari
Clara
C
Schiantarelli
Mariagrazia
M
Vigano
Immacolata
I
Izzi
Piero
P
Ferremi
Arnalda
A
Lanfranchi
Mauro
M
Mazzuccato
Gianpiero
G
Carosi
Umberto
U
Tirelli
Giuseppe
G
Rossi
Maurizio
M
Mazzuccato
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018952:Antigens, CD34; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003131:Combined Modality Therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000276:immunology / Q000628:therapy*; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D016879:Salvage Therapy; D015996:Survival Rate; D014182:Transplantation, Autologous; D019562:Viral Load
D019380:Anti-HIV Agents; D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor