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 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.
Krishnan
Amrita
A
City of Hope Hematologic Neoplasia Program, City of Hope Cancer Center, Duarte, CA 90101, USA. akrishnan@coh.org
Molina
Arturo
A
Zaia
John
J
Smith
David
D
Vasquez
Debbie
D
Kogut
Neil
N
Falk
Peter M
PM
Rosenthal
Joseph
J
Alvarnas
Joseph
J
Forman
Stephen J
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D002648:Child; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous