High-dose therapy plus autologous hematopoietic stem cell transplantation for human immunodeficiency virus (HIV)-related lymphoma: results and impact on HIV disease.
OBJECTIVE
The aim of this study was to assess the feasibility of high-dose chemotherapy plus autologous hematopoietic stem cell transplantation (HDC/AHSCT) in AIDS-related lymphoma (ARL), and its long-term impact in patients with human immunodeficiency virus (HIV) treated with highly active antiretroviral therapy (HAART).


METHODS
Fourteen patients with relapsed or resistant ARL (8 with nonHodgkin's lymphoma and 6 with Hodgkin's disease) were treated with HDC/AHSCT while on HAART. HIV-1 proviral DNA load was quantified in 11 grafts.


RESULTS
Hematologic reconstitution was good. No toxic deaths occurred. Despite the large number of cells harboring HIV-1 proviral DNA (105 to 109) re-infused with the graft, HAART controlled HIV replication and led to CD4 cell reconstitution in 7 of the 8 patients who were still alive six months after AHSCT. Only two patients had opportunistic infections after AHSCT. There were no significant changes in viral load (VL) or CD4+ cell counts in most patients. One month after AHSCT, 10 patients were in complete remission (CR). Seven patients died from lymphoma between 1 and 10 months after AHSCT, and a further two patients died in CR (one from AIDS at 16 months, one from another tumor at 28 months). Five patients are alive: four are in CR, 14, 19, 32 and 49 months after AHSCT (median CD4+ cell count= 445/mL; undetectable VL in 3 patients), and one is being treated for relapsed lymphoma 36 months after AHSCT.


CONCLUSIONS
HDC/AHSCT is feasible in AIDS-related lymphoma, in terms of harvesting, engraftment, adverse events and HIV control. It should be proposed to patients with poor-prognosis chemosensitive lymphoma.
Gabarre
Jean
J
Service d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Paris, France. jean.gabarre@psl.ap-hop-paris.fr
Marcelin
Anne-Geneviève
AG
Azar
Nabih
N
Choquet
Sylvain
S
Lévy
Vincent
V
Lévy
Yves
Y
Tubiana
Roland
R
Charlotte
Frédéric
F
Norol
Françoise
F
Calvez
Vincent
V
Spina
Michele
M
Vernant
Jean-Paul
JP
Autran
Brigitte
B
Leblond
Véronique
V
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011533:Proviruses / Q000302:isolation & purification; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D004279:DNA, Viral