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Autologous stem cell transplantation for lymphoma in HIV+ patients: higher rate of infections compared with non-HIV lymphoma

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Abstract

Autologous hematopoietic stem cell transplantation (ASCT) is a well-established treatment strategy in HIV-related lymphoma patients (HIV+ Ly). Nevertheless, current evidence is mainly based on reports from specialized centers, multicentre heterogeneous studies, noncomparative analyses, or registry data-based comparisons. Likewise, the risk of infections reported so far for this population, seems to be similar to that of HIV- patients, and it does not seem to impact on mortality. We report a single-center retrospective comparative analysis of AHCT procedural results, infectious complications and survival in HIV+ Ly matched with a non-HIV comparative cohort. Thirty-three HIV+ patients and 45 matched controls, who underwent ASCT between 2000 and 2016, were included. Transplant-related toxicity, event-free survival, relapse rate, and overall survival were similar in both groups. Engraftment was delayed in HIV+ Ly (neutrophils: 15 vs 12 days (p = 0.0001), and platelets 39 vs 16 days (p = 0.00001)). Bacterial infections during the pre-engraftment period were more frequent in HIV+ Ly (RR 2.24, p = 0.017), as well as viral infections in the postengraftment period (RR 3.22, p = 0.004). CMV reactivation was more frequent in HIV+ Ly (39% vs 15% p = 0.007). In conclusion, ASCT is viable and effective in HIV+ Ly, but it is associated with a higher risk of infection.

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Fig. 1: Cumulative incidence of neutrophis and platelets engraftment.
Fig. 2: Infections incidence density by period.
Fig. 3: Risk of infections by pathogen group.
Fig. 4: Cumulative incidence of CMV reactivation.
Fig. 5: Lymphocyte reconstitution.
Fig. 6: Overall survival and event-free survival.
Fig. 7: Cumulative incidence of relapse and non-relapse mortality.

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Acknowledgements

The authors greatly acknowledge the members of the Infectious Diseases and Microbiology Department of Hospital Gregorio Marañón for their essential contribution to HIV-infected patients’ diagnosis, treatment optimization, and follow-up. I am grateful to Dr Gayoso for his dedication and support in my training in transplant and lymphoma field. I want to give special thanks to Dr Juan Churruca for his important contribution to the development of this study and I want to particularly thank to JLDM and MK for giving me the opportunity to carry out this study.

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Authors and Affiliations

  1. Haematology and Haemotherapy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Mariana Bastos-Oreiro, Pascual Balsalobre, Nieves Dorado, Rebeca Bailen, Gillen Obreoscoa, Javier Anguita, David Serrano, José Luis Díez-Martín & Mi Kwon

  2. Gregorio Marañón Health Research Institute, Madrid, Spain

    Mariana Bastos-Oreiro, Pascual Balsalobre, Nieves Dorado, Rebeca Bailen, Gillen Obreoscoa, Javier Anguita, José Luis Díez-Martín & Mi Kwon

  3. Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Pilar Miralles & Juan Berenguer

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  1. Mariana Bastos-Oreiro
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Contributions

MB, PB, JLDM, and MK, were responsible for the study design. MB, ND, RB, and DS were involved in data collection and statistical analysis, MB and MK wrote the paper and all authors contributed to the revision of the paper.

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Correspondence to Mariana Bastos-Oreiro.

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The study was conducted in accordance with the Declaration of Helsinki. The institutional review board approved the study and written informed consent was obtained from all participants regarding data collection and analysis for publication.

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Bastos-Oreiro, M., Balsalobre, P., Miralles, P. et al. Autologous stem cell transplantation for lymphoma in HIV+ patients: higher rate of infections compared with non-HIV lymphoma. Bone Marrow Transplant 55, 1716–1725 (2020). https://doi.org/10.1038/s41409-020-0846-0

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