title: High-dose therapy and autologous peripheral blood stem cell transplantation as salvage treatment for AIDS-related lymphoma: long-term results of the Italian Cooperative Group on AIDS and Tumors (GICAT) study with analysis of prognostic factors.
abstract: After the introduction of highly active antiretroviral therapy (HAART), intensive treatment, including high-dose therapy (HDT) and peripheral blood stem cell transplantation (PBSCT), has become feasible in HIV-positive patients with Hodgkin (HL) and non-Hodgkin (NHL) lymphoma. Herein, we report the long-term results, on an intention-to-treat basis, of a prospective study on HDT and PBSCT in 50 HIV-positive HAART-responding patients with refractory/relapsed lymphoma. After debulking therapy, 2 patients had early toxic deaths, 10 had chemoresistant disease, 6 failed stem cell mobilization, 1 refused collection, and 4 progressed soon after PBSC harvest. Twenty-seven actually received transplant. Twenty-one patients are alive and disease-free after a median follow-up of 44 months (OS, 74.6%; PFS, 75.9%). Only lymphoma response significantly affected OS after transplantation. In multivariate analyses both lymphoma stage and low CD4 count negatively influenced the possibility to receive transplant. Median OS of all 50 eligible patients was 33 months (OS, 49.8%; PFS, 48.9%). Low CD4 count, marrow involvement, and poor performance status independently affected survival. PBSCT is a highly effective salvage treatment for chemosensitive AIDS-related lymphoma. It seems rational to explore its use earlier during the course of lymphoma to increase the proportion of patients who can actually receive transplant.
authors.affiliation: Division of Hematology, Spedali Civili di Brescia, Brescia, Italy. sandrore@aruba.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Re
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Michieli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Casari
authors.forename: Bernardino
authors.initials: B
authors.lastname: Allione
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rupolo
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Rosa
authors.initials: R
authors.lastname: Manuele
authors.forename: Emanuela
authors.initials: E
authors.lastname: Vaccher
authors.forename: Mario
authors.initials: M
authors.lastname: Mazzucato
authors.forename: Luciano
authors.initials: L
authors.lastname: Abbruzzese
authors.forename: Pierino
authors.initials: P
authors.lastname: Ferremi
authors.forename: Giampiero
authors.initials: G
authors.lastname: Carosi
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007558:Italy; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D014182:Transplantation, Autologous