Originally published as JCO Early Release 10.1200/JCO.2008.18.2683 on March 30 2009

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Autologous Stem-Cell Transplantation in Patients With HIV-Related Lymphoma

Pascual Balsalobre, José L. Díez-Martín, Alessandro Re, Mariagrazia Michieli, José M. Ribera, Carmen Canals, Anne Rosselet, Eulogio Conde, Rosario Varela, Kate Cwynarski, Ian Gabriel, Philippe Genet, Gaelle Guillerm, Bernardino Allione, Augustin Ferrant, Pierre Biron, Ildefonso Espigado, David Serrano, Anna Sureda

From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura a Carattere Scientifico, Aviano; Hospital S.S. Antonio e Biagio, Alessandria, Italy; Centre Hospitalier Universitaire Vaudois, Lausane, Switzerland; Royal Free Hospital; Hammersmith Hospital, London, United Kingdom; Hopital Victor Dupouy, Argenteuil; H. Augustin-Morvan, Brest; Centre Leon Berard, Lyon, France; and Cliniques Universitaires St Luc, Brussels, Belgium.

Corresponding author: José L. Díez-Martín, MD, PhD, Hematology Department, Hospital General Universitario Gregorio Marañón, Pabellón Oncologico (Hematología), 1^a pta, C/Dr Esquerdo 46, 28007 Madrid, Spain; e-mail: jdiez.hgugm{at}salud.madrid.org.

Purpose Peripheral-blood autologous stem-cell transplantation (ASCT) in patients with HIV-related lymphoma (HIV-Ly) has been reported as a safe and useful procedure. Herein we report the European Group for Blood and Marrow Transplantation experience on patients with HIV-Ly undergoing ASCT.

Patients and Methods This was a retrospective, multicentric, registry-based analysis.

Results Since 1999, 68 patients from 20 institutions (median age, 41 years; range, 29 to 62 years) were included, diagnosed with non-Hodgkin's lymphoma (NHL; n = 50) or Hodgkin's lymphoma (n = 18). At the time of ASCT, 16 patients were in first complete remission (CR1); 44 patients were in CR more than 1, partial remission, or chemotherapy-sensitive relapse (chemo-S); and eight patients had chemotherapy-resistant disease. The median number of CD34⁺ cells infused was 4.5 x 10⁶/kg (range, 1.6 to 21.2 x 10⁶/kg). Median time to neutrophil and platelet engraftment were 11 days (range, 8 to 36 days) and 14 days (range, 6 to 455 days), respectively, with a cumulative incidence (CI) at 1 year of 95.6% and 87%, respectively. CI of nonrelapse mortality (NRM) was 7.5% at 12 months after ASCT, mainly because of bacterial infections. CI of relapse was 30.4% at 24 months, statistically related with not being in CR at ASCT (relative risk [RR] = 3.6), NHL histology other than diffuse large B-cell lymphoma (RR = 3.4), and use of more than two previous treatment lines (RR = 3). At a median follow-up of 32 months (range, 2 to 81 months), progression-free survival (PFS) was 56%. Patients not in CR or with refractory disease at ASCT had poorer PFS (RR = 2.4 and 4.8, respectively).

Conclusion Similarly to HIV-negative patients with lymphoma, ASCT is a useful treatment for patients with HIV-Ly and is associated with low NRM, mainly when performed in early stages and chemo-S disease.

Both P.B. and J.L.D.-M. contributed equally to this work.

Written on behalf of European Group for Blood and Marrow Transplantation Lymphoma Working Party.

Supported in part by Grants No. BA05/90038, FIS 06/60230, and FIS 05/2505 by the Spanish Ministry of Health, Grant No. 07/589 by Fundacion MMA and the Program for Research Intensification in Nursing of the Agencia Pedro Laín Entralgo (Com. Madrid) and Fundación para la Investigación Biomédica Hospital Gregorio Marañón.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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