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Autologous stem cell transplantation offers safe and effective – and potentially curative – option for patients with HIV-associated lymphoma

New research published online in Blood, the Journal of the American Society of Hematology (ASH), challenges the generally held belief that individuals with HIV and aggressive lymphoma are not candidates for standard treatment.

According to researchers, people with HIV-associated lymphoma who receive autologous stem cell transplant have similar survival rates and are no more at risk of serious complications compared to those without HIV receiving this therapy.

People living with human immunodeficiency virus, or HIV – even those whose infection is well controlled with modern combination antiretroviral therapy – remain at significant risk of cancer. The risk of non-Hodgkin lymphoma alone is up to 25-fold greater for people with HIV than for those without the infection, and malignancies have quickly become a leading cause of death as people with HIV live longer.

Autologous hematopoietic cell transplant (AHCT) – a procedure in which healthy cells are taken from the patient’s own blood or bone marrow and administered to help them recover after high-dose chemotherapy – has become the standard of care for treating relapsed and treatment-resistant Hodgkin and non-Hodgkin lymphoma; however, its use in HIV-infected patients is largely limited to centers with HIV-specific expertise.

Clinicians have historically been hesitant to treat HIV patients with stem cell transplant due to concerns that their immune systems would not effectively recover after intensive chemotherapy or that the procedure would cause excessive toxicities or infections post-transplant. However, in this Phase II clinical trial, designed to prospectively evaluate the safety and effectiveness of ACHT for patients with HIV-related lymphoma, researchers discovered that this population had no greater likelihood of developing these complications compared to those without the virus.

“Overall survival for patients with HIV infection after transplant is comparable to that seen in people who were not HIV-infected,” said lead author Joseph Alvarnas, MD, associate clinical professor in the department of hematology and director of value-based analytics at the City of Hope National Medical Center in Duarte, CA.

The data also show that transplant-related toxicities in these patients are comparable to those observed in patients without HIV.