High-dose therapy plus autologous hematopoietic stem cell transplantation for human immunodeficiency virus (HIV)-related lymphoma: results and impact on HIV disease.

BACKGROUND AND OBJECTIVES The aim of this study was to assess the feasibility of high-dose chemotherapy plus autologous hematopoietic stem cell transplantation (HDC/AHSCT) in AIDS-related lymphoma (ARL), and its long-term impact in patients with human immunodeficiency virus (HIV) treated with highly active antiretroviral therapy (HAART). DESIGN AND METHODS Fourteen patients with relapsed or resistant ARL (8 with nonHodgkin's lymphoma and 6 with Hodgkin's disease) were treated with HDC/AHSCT while on HAART. HIV-1 proviral DNA load was quantified in 11 grafts. RESULTS Hematologic reconstitution was good. No toxic deaths occurred. Despite the large number of cells harboring HIV-1 proviral DNA (105 to 109) re-infused with the graft, HAART controlled HIV replication and led to CD4 cell reconstitution in 7 of the 8 patients who were still alive six months after AHSCT. Only two patients had opportunistic infections after AHSCT. There were no significant changes in viral load (VL) or CD4+ cell counts in most patients. One month after AHSCT, 10 patients were in complete remission (CR). Seven patients died from lymphoma between 1 and 10 months after AHSCT, and a further two patients died in CR (one from AIDS at 16 months, one from another tumor at 28 months). Five patients are alive: four are in CR, 14, 19, 32 and 49 months after AHSCT (median CD4+ cell count= 445/mL; undetectable VL in 3 patients), and one is being treated for relapsed lymphoma 36 months after AHSCT. INTERPRETATION AND CONCLUSIONS HDC/AHSCT is feasible in AIDS-related lymphoma, in terms of harvesting, engraftment, adverse events and HIV control. It should be proposed to patients with poor-prognosis chemosensitive lymphoma.