ASH 2014: HIV-Related Lymphoma Can Be Safely Treated With Autologous Hematopoietic Cell Transplant
Patients with human immunodeficiency virus (HIV)-related relapsed/refractory lymphoma can safely undergo autologous hematopoietic cell transplant, according to results of a phase II multicenter trial. At many centers, patients with HIV-related lymphoma are currently excluded from this potentially curative treatment due to concern of increased risk of infection in immunocompromised patients.
The study findings were presented at a press conference during the 56th American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 674).
Impact on Clinical Trial Design
Autologous hematopoietic cell transplant resulted in an estimated 1-year overall survival of 86.6% and progression-free survival of 82.3% in patients for whom prior therapy had failed. The estimated rate of disease progression at 1 year was 12.5%, and the estimated mortality was 5%.
“Chemotherapy-sensitive patients with relapsed/refractory HIV-related lymphoma may successfully undergo autologous hematopoietic cell transplant with favorable outcomes. Our study shows that exclusion from clinical trials on the basis of HIV infection alone is no longer justified. In fact, in clinical practice, patients with controlled HIV infection—with emphasis on the word ‘controlled’—should be receiving transplants as standard of care,” said lead study author Joseph Alvarnas, MD, Director of Medical Quality at City of Hope, Duarte, California.
“Now that we have effective therapies for AIDS, we tend to trivialize it as a risk factor for lymphoma, but it is still a risk factor. We have excellent treatment for patients with lymphoma, yet HIV infection remains an exclusion criterion for most autologous hematopoietic cell transplant therapeutic trials. We conducted this study to see whether we could extend autologous hematopoietic cell transplant to HIV-infected patients with lymphoma at nonspecialty centers,” he told the audience.
Study Details
The single-arm, multi-institutional trial was conducted jointly by the Blood and Marrow Transplant Clinical Trials Network and the AIDS Malignancy Clinical Trials Consortium. The 16 transplant centers included in the study do not specialize in HIV and AIDS treatment, making it possible to duplicate the treatment at a broader number of nonspecialized centers, noted the authors.
Study results were based on 40 HIV-infected patients with lymphoma who were at high risk of disease progression. All underwent autologous hematopoietic cell transplant, receiving a modified BEAM (carmustine [BiCNU], etoposide, cytarabine, and melphalan) regimen, and blood stem cell grafts. Antiretroviral therapy for HIV infection was withheld during the preparative regimen and resumed after the resolution of gastrointestinal toxicities. All patients received standard institutional supportive care post-transplant.
“Patients had no problem mobilizing stem cells,” Dr. Alvarnas said.
Dr. Alvarnas said that a case-control study of 151 matched non–HIV-infected patients with lymphoma who underwent autologous hematopoietic cell transplant showed no significant differences in overall mortality compared with the patients in his study.
The study authors reported no potential conflicts of interest.
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