Immune recovery after autologous stem cell transplantation is not different for HIV-infected versus HIV-uninfected patients with relapsed or refractory lymphoma.
BACKGROUND
High-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are feasible and effective salvage treatments for human immunodeficiency virus (HIV)-related relapse or refractory lymphoma. Among the main concerns with ASCT in HIV-infected persons is the additional immune depletion caused by treatment, which could amplify the preexisting immune deficit. The aims of our study were to assess the impact of conventional chemotherapy before salvage treatment was administered, in this population, and to evaluate immune reconstitution dynamics during ASCT.


METHODS
All 33 HIV-infected and HIV-uninfected patients who underwent comparable ASCT protocols at the National Cancer Institute (Aviano, Italy) who underwent 1 month of follow-up after transplantation were included in a prospective immunological study. Demographic, clinical, and immunovirological data were obtained before administration of induction therapy, during transplantation, and at 24 months of follow-up.


RESULTS
Before HDC, no significant differences were observed in CD4(+) cell subsets and signal joint T cell receptor excision circles (sjTRECs), although HIV-infected persons had inverted ratios of CD4(+) cells to CD8(+) cells because they had higher CD8(+) T cell counts, compared with HIV-uninfected persons. After ASCT, this inversion was also observed in HIV-uninfected patients up to 24 months. CD4(+) cell subsets had similar recoveries, with a temporary setback in HIV-infected persons 3 months after reinfusion, together with an increase in infections. sjTRECs demonstrated similar dynamics in both populations and serve as a useful predictive marker of recovery of CD4(+) cell subsets. No significant changes emerged in HIV DNA levels during the follow-up period, with values at 24 months significantly lower than those at baseline.


CONCLUSIONS
Our study demonstrated that ASCT in HIV-infected persons with lymphoma does not worsen the initial immune impairment and does not enhance viral replication or the peripheral HIV reservoir in the long term.
Simonelli
Cecilia
C
Division of Medical Oncology A, National Cancer Institute, Aviano, Italy.
Zanussi
Stefania
S
Pratesi
Chiara
C
Rupolo
Maurizio
M
Talamini
Renato
R
Caffau
Cristina
C
Teresa Bortolin
Maria
M
Tedeschi
Rosamaria
R
Basaglia
Giancarlo
G
Mazzucato
Mario
M
Manuele
Rosa
R
Vaccher
Emanuela
E
Spina
Michele
M
Tirelli
Umberto
U
Michieli
Mariagrazia
M
De Paoli
Paolo
P
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D007107:Immune System / Q000187:drug effects; D008223:Lymphoma / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012038:Regeneration; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D013950:Thymus Gland / Q000502:physiology; D014182:Transplantation, Autologous; D019562:Viral Load
D000970:Antineoplastic Agents