LY-04. Prospective study: autologous hematopoietic stem cell transplantation in patients with HIV-related lymphoma
Marina O. Popova, Yuliya A. Rogacheva, Andrey M. Chekalov, Ivan V. Tsygankov, Kirill V. Lepik, Lilia V. Stelmakh, Vadim V. Baykov, Natalia B. Mikhailova, Alexander D. Kulagin
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Contact: Dr. Marina O. Popova, e-mail: marina.popova.spb@gmail.com
Summary
Despite the widespread use of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection is associated with an increased incidence of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Concurrently, autologous stem cell transplantation (ASCT) becomes a feasible approach to either rescue or consolidate HIV-related lymphoma patients. However, there is only limited number of prospective matched case-controlled studies to prove the safety and efficacy of ASCT in HIV-related lymphoma.
Patients and methods
Between August 2014 and May 2022, fifteen patients with HIV-related lymphoma who underwent ASCT were included in prospective matched case-control study (study group, n=15). Sixty non-HIV-infected patients were enrolled into the control group (n=60, 1:4). Their median age was 35 (19-66) y.o. The underlying diseases in study group were as follows: 7 cases of HL (46.6%), and 8 patients with NHL (53.4%), with complete remission prior to ASCT (73.3%). Conditioning regimen was BEAM with BCNU replaced by Bendamustine (160 mg/m2/day on D-7, D-6). HIV viral load was undetectable, and the median number of CD4+ cells was 360 cells/mcL (133-715). All patients received HAART schedules. The median follow-up time was 2.9 years (1 day to 5.2 years). The primary endpoints were, as follows, overall survival (OS), progression-free survival (PFS) and time-to-progression (TTP) 2 years after ASCT. Secondary endpoints included terms of hematopoietic recovery, organ toxicity and transplant-related mortality (TRM). Common Terminology Criteria for Adverse Events (CTCAE 5.0) were used for the toxicity analysis.
Results
The 3-year OS (n=75) was 88%: 86.7% in the study group, 88.3% among control group, and did not significantly differ between the groups (p= 0.876). Progression-free survival (PFS) at 3 years was 66.7% in the study group, and was not different against the control group (76.7%, p=0.411). Time-to-progression (TTP) at 3 years was 20% in study group, versus 18.3% in controls (p=0.796). Complete remission at the time of ASCT was associated with better PFS levels (p=0.049) and TTP (p=0.052) in the total group. The median recovery terms for leukocytes, neutrophils, and platelets were, respectively, D+16 (10-25), D+15 (12-30), and D+15 (11-31) in study group compared with D+15 (10-22), D+14 (10-23), and D+14 (8-31) in control group. There was no intergroup difference in the rates of organ toxicities, according to CTCAE criteria.
Conclusion
Three-year overall survival in the patients with HIV-related lymphoma was 86.7%; PFS, 66.7%, and TTP, 20%. Complete remission at the moment of ASCT improved PFS and TTP levels in the total group. Our data provide further evidence that ASCT is a safe and effective option for the patients with HIV-related lymphoma.
Keywords
Hematopoietic stem cell transplantation, autologous, lymphoma, HIV-related.
