The Impact of HIV Infection on Stem Cell Transplants for Lymphoma

Concern persists among physicians who treat HIV-associated lymphoma with stem cell transplants due to the risk of harming the immune system.

Patients with HIV-associated lymphoma who had an autologous stem cell transplant did not face a greater risk of serious complications and had similar survival rates as HIV-negative patients undergoing the same therapy.

Although autologous hematopoietic cell transplant (AHCT) is the standard of care for relapsed or treatment-resistant Hodgkin and non-Hodgkin lymphoma, physicians have raised concerns about treating HIV patients with this approach due to the risky effects it could have on their immune system, according to a study published in Blood.

HIV-positive patients face a significant risk of developing cancer, while the risk of developing non-Hodgkin lymphoma is up to 25-fold greater than in HIV-negative patients. During the study, researchers harvested the patients’ stem cells and froze them until the cells were ready to be injected back into patients.

Between April 2010 and March 2013, 43 patients with treatable HIV who had chemotherapy-sensitive relapsed or treatment-resistant non-Hodgkin or Hodgkin lymphoma were enrolled in the phase 2 trial. There were 40 patients who received AHCT at 16 different centers, while 3 patients did not receive a transplant because of disease progression.

Based on institutional standards, patients received support care after AHCT, as well as frequent lab testing. The disease status was assessed before AHCT, on day 100, and 1 year after transplantation.

Using data reported to the Center for International Blood & Marrow Transplant Research, researchers compared the study participants to 151 similar HIV-negative patients who underwent the same treatment for lymphoma.

At a median follow-up of 25 months, overall survival in HIV-positive patients at 1-year post-transplant was 87.3%, compared with 87.7% in HIV-negative patients.

At 1 year, transplant-related death because of recurrence of lymphoma, cardiac arrest, and fungal infection was 5.2% in HIV-positive patients, which was comparable to non-HIV patients. Furthermore, 1-year post-transplant, 82% of HIV-positive patients continued to have undetectable levels of the virus.

The median time for recovery of white blood cells and platelets was 11 in HIV-positive patients and 18 days in HIV-negative patients.

“When you look at people's recovery, recovery of their T-cells and CD4+ and suppression of viral load, we don't see people losing control of HIV infection, nor do they have evidence of additional immunological deficits following transplant. I think that's very reassuring,” said lead study author Joseph Alvarnas, MD.

Additional clinical trial research remains ongoing to evaluate the safety of allogeneic hematopoietic cell transplantation for HIV-positive patients who suffer from blood cancers.

“These findings are remarkably important for a group of patients who, up until now, have been inconsistently treated,” Alvarnas said. “Transplantation allows clinicians to treat the cancer most effectively by using more intense doses of chemotherapy than can typically be given, while avoiding fears of wiping out the bone marrow. Based on our data, autologous stem cell transplant should be considered the standard of care for patients with HIV-related lymphomas for the same indications and under the same circumstances that we would use it in patients without HIV infection.”