ISSN 1866-8836
Клеточная терапия и трансплантация

LY-05. Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of prospective matched case-control study

Marina O. Popova, Ivan V. Tsygankov, Yuliya A. Rogacheva, Kirill V. Lepik, Yuri R. Zalyalov, Lilia V. Stelmakh, Vadim V. Baykov, Sergey N. Bondarenko, Natalya B. Mikhailova, Alexander D. Kulagin

RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, St. Petersburg, Russia

Contact: Dr. Marina O. Popova, e-mail: marina.popova.spb@gmail.com

doi 10.18620/ctt-1866-8836-2020-9-3-1-152

Summary

Introduction

Despite widespread use of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection is associated with an increased incidence of lymphomas. In this aspect, high-dose chemotherapy with autologous stem cell transplantation (ASCT) becomes a feasible approach to either rescue or consolidate the HIV-related lymphoma patients. However, there is a limited number of prospective matched case-controlled studies to prove the safety and efficacy of ASCT in HIV-related lymphoma. Our aim was to prospectively evaluate safety and efficacy of ASCT for the patients with HIV-related lymphoma.

Patients and methods

Between January 2016 and January 2020, twelve patients with HIV-related lymphoma who underwent ASCT were included in prospective matched case-control study (study group, n=12). Forty-eight non-HIV-infected patients were enrolled in the control group (n=48, 1:4). The median age was 34 (19-66) y.o. The underlying diseases in study group were as follows: Hodgkin lymphoma (HL), n=7 (58.3%), and non-Hodgkin lymphoma (NHL), n=5 (41.7%), complete remission at the moment of ASCT was achieved in 66.7%. In most patients, the conditioning regimen was BEAM with BCNU replacement by Bendamustine 160 mg/m2/day at D-7, D-6, and etoposide dose reduction to 50%. HIV viral load was undetectable; the median number of CD4+ cells was 471.5 (210-715) cells/mcl; all the patients received ART. The median follow up time was 17.5 (1-43) months. The primary endpoints were: overall survival (OS), progression-free survival (PFS) and time-to-progression (TTP) at 2 years after ASCT. Secondary endpoints were as follows: time to hematopoietic recovery, toxicity and transplant-related mortality (TRM). Common Terminology Criteria for Adverse Events (CTCAE 5.0) for the toxicity analyse have been used.

Results

Two-year OS (n=60) was 90% (91.7% in the study group, and 89.9% in the control group), with no significant difference between the groups (p=0.763). PFS at 2 years in the study group was 75%, thus being not different from the control group (70.8%; p=0.777). TTP at 2 years was 14.6% in the study group and 16.7% in the controls (p=0.643). Complete remission state at the moment of ASCT improved the PFS (p=0.03) and TTP values (p=0.044) in the entire group. The median time for recovery of leukocytes, neutrophils, and platelets was D+14.5 (10-25), D+17 (12-30), D+15.5 (11-31), respectively, in the study group and D+14 (10-22), D+15 (10-23), D+15 (8-31) in the controls. Neutrophil recovery was significantly delayed in the study group (p=0.04). There was no difference in the rate of toxicity according to CTCAE. TRM rate at 2 years was 8.3% in the study group, and 6.2% among control patients (p=0.8).

Conclusion

Two-year overall survival after ASCT in patients with HIV-related lymphoma was 91.7%, PFS was 75%, TTP was 14.6%, and TRM was 8.3%, which did not differ significantly from the control group. Incomplete remission of the disease at the moment of ASCT was associated with decreased PFS and increased TTP in the whole group. Only neutrophil recovery was significantly delayed after ASCT in the patients with HIV-related lymphoma. Our data provide further evidence that ASCT with adapted BEAM conditioning is a safe and effective approach for the patients with HIV-related lymphoma.

Keywords

HIV-related lymphoma, autologous hematopoietic cell transplantation, engraftment, matched case-control study.


Volume 9, Number 3
09/30/2020

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doi 10.18620/ctt-1866-8836-2020-9-3-1-152

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