- 188: Blood. 2009 May 18.
High dose therapy and autologous peripheral blood stem cell transplantation as salvage treatment for AIDS-related lymphoma: long term results of the GICAT study with analysis of prognostic factors.
Re A, Michieli M, Casari S, Allione B, Cattaneo C, Rupolo M, Spina M, Manuele R, Vaccher E, Mazzucato M, Abbruzzese L, Ferremi P, Carosi G, Tirelli U, Rossi G.
Division of Hematology, Spedali Civili, Brescia, Italy.
After the introduction of highly active antiretroviral therapy (HAART), intensive treatment, including high-dose therapy (HDT) and peripheral blood stem cell transplantation (PBCST), has become feasible in HIV-positive patients with Hodgkin (HL) and non-Hodgkin (NHL) lymphoma. Herein we report the long term results, on an intention-to-treat basis, of a prospective study on HDT and PBSCT in 50 HIV-positive HAART-responding patients with refractory/relapsed lymphoma (31 NHL, 19 HL). After debulking therapy, two patients had early toxic deaths, 10 chemoresistant disease, 6 failed stem cell mobilization, 1 refused collection and 4 progressed soon after PBSC harvest. Twenty-seven actually received transplant. Toxicity was acceptable. Twenty-one patients are alive and disease-free after a median follow-up of 44 months (OS 74.6%, PFS 75.9%). Only lymphoma response significantly affected OS after transplant. In multivariate analyses both lymphoma stage and low CD4-count negatively influenced the possibility to receive transplant. Median OS of all 50 eligible patients was 33 months (OS 49.8%, PFS 48.9%). Low CD4-count, marrow involvement and poor performance-status independently affected survival. PBSCT is an highly effective salvage treatment for chemosensitive AIDS-related lymphoma. It seems rational to explore its use earlier during the course of lymphoma to increase the proportion of patients who can actually receive transplant.