title: Allogeneic hematopoietic cell transplantation in human immunodeficiency virus-positive patients with hematologic disorders: a report from the center for international blood and marrow transplant research.
abstract: The role of allogeneic hematopoietic cell transplantation (alloHCT) in human immunodeficiency virus (HIV)-positive patients is not known. Using the Center for International Blood and Marrow Transplant Research database, we retrospectively evaluated 23 HIV-positive patients undergoing matched sibling donor (n = 19) or unrelated donor (n = 4) alloHCT between 1987 and 2003. The median age at alloHCT was 32 years. Indications for alloHCT were diverse and included malignant (n = 21) and nonmalignant (n = 2) hematologic disorders. Nine patients (39%) underwent transplantation after 1996, the approximate year that highly active antiretroviral therapy became standard treatment. The median time to neutrophil engraftment was 16 days (range, 7 to 30 days), and the cumulative incidences of grade II-IV acute graft-versus-host disease (aGVHD) at 100 days, chronic GVHD (cGVHD), and survival at 2 years were 30% (95% confidence interval [CI] = 14% to 50%), 28% (95% CI = 12% to 48%), and 30% (95% CI = 14% to 50%), respectively. At a median follow-up of 59 months, 6 patients were alive. Survival appears to be better in the patients undergoing alloHCT after 1996; 4 of these 9 patients survived, compared with only 2 of 14 those undergoing transplantation before 1996. These data suggest that alloHCT is feasible for selected HIV-positive patients with malignant and nonmalignant disorders. Prospective studies are needed to evaluate the safety and efficacy of this modality in specific diseases in these patients.
authors.affiliation: Division of Haematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. vikas.gupta@uhn.on.ca
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Marcie
authors.initials: M
authors.lastname: Tomblyn
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Pedersen
authors.forename: Harry L
authors.initials: HL
authors.lastname: Atkins
authors.forename: Minoo
authors.initials: M
authors.lastname: Battiwalla
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Gress
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Pollack
authors.forename: Jan
authors.initials: J
authors.lastname: Storek
authors.forename: Jill C
authors.initials: JC
authors.lastname: Thompson
authors.forename: Pierre
authors.initials: P
authors.lastname: Tiberghien
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: Young
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality / Q000628:therapy; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D006402:Hematologic Diseases / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous