HIV No Bar to Transplant for Lymphoma

Patients with HIV-related lymphoma should be offered an autologous stem-cell transplant, a researcher said here.

That's the implication of a clinical trial that showed people with HIV who undergo transplant for lymphoma have outcomes similar to people without the virus, according to Joseph Alvarnas, MD, of City of Hope Comprehensive Cancer Center in Duarte, Calif.

"People ... with well-controlled HIV should be offered a transplant as a standard of care," Alvarnas told MedPage Today at the American Society of Hematology (ASH) annual meeting.

HIV infection is associated with an increased risk of both Hodgkin's and non-Hodgkin's lymphoma, Alvarnas noted during an ASH press briefing, and many clinicians have been reluctant to offer transplant because of the risk of infection.

In the era of highly active anti-retroviral therapy (HAART), that might not make sense, Alvarnas said, but HIV infection remains an exclusion criterion for most therapeutic trials of autologous stem-cell transplant.

To help settle the question, he and colleagues studied outcomes for 40 HIV-positive patients with lymphoma who underwent a transplant, and compared outcomes to a cohort of 151 HIV-negative patients matched for age, performance score, disease, and disease stage.

The combination HIV therapy was stopped during the preparative BEAM regimen (for BCNU, etoposide, cytarabine and melphalan) and resumed afterward, he reported.

Before the transplant, 30 patients were in complete remission, eight were in partial remission, and two had progressive disease. Viral load was undetectable in 31 patients and low in the remaining nine, while the median count of CD4-positive T cells was 250.5 per mcL.

The primary endpoint was overall survival (OS) and secondary endpoints included progression-free survival (PFS).

A year after the transplant, OS was estimated to be 86.6% and PFS was 82.3%. The outcomes were not statistically different from those in the HIV-negative cohort.

The bottom line, Alvarnas concluded, is that there's no reason to exclude patients from clinical trials of transplantation or from transplants in clinical practice.

Indeed, the standard of care should now change, commented Brian Bolwell, MD, of the Cleveland Clinic's Taussig Cancer Institute.

"Historically, when patients [with HIV] relapsed, clinicians were reluctant to transplant them because of the risk of infection," he told MedPage Today.

But the study by Alvarnas and colleagues shows "you can transplant them safely and the outcomes are good. Practice should change."

In some centers, standard practice is still not to offer transplant to HIV patients, even if the virus is well controlled, commented Brad Kahl, MD, of the University of Wisconsin School of Medicine in Madison, who moderated the ASH press briefing.