Clin Infect Dis. 2010 Jun 15;50(12):1672-9.
Immune recovery after autologous stem cell transplantation is
not different for HIV-infected versus HIV-uninfected patients
with relapsed or refractory lymphoma.
Simonelli C, Zanussi S, Pratesi C, Rupolo M, Talamini R, Caffau
C, Teresa Bortolin M, Tedeschi R, Basaglia G, Mazzucato M,
Manuele R, Vaccher E, Spina M, Tirelli U, Michieli M, De Paoli
P.
Division of Medical Oncology A, National Cancer Institute,
Aviano, Italy.
Abstract
BACKGROUND: High-dose chemotherapy (HDC) and autologous stem
cell transplantation (ASCT) are feasible and effective salvage
treatments for human immunodeficiency virus (HIV)-related
relapse or refractory lymphoma. Among the main concerns with
ASCT in HIV-infected persons is the additional immune depletion
caused by treatment, which could amplify the preexisting immune
deficit. The aims of our study were to assess the impact of
conventional chemotherapy before salvage treatment was
administered, in this population, and to evaluate immune
reconstitution dynamics during ASCT. METHODS: All 33
HIV-infected and HIV-uninfected patients who underwent
comparable ASCT protocols at the National Cancer Institute (Aviano,
Italy) who underwent 1 month of follow-up after transplantation
were included in a prospective immunological study. Demographic,
clinical, and immunovirological data were obtained before
administration of induction therapy, during transplantation, and
at 24 months of follow-up. RESULTS: Before HDC, no significant
differences were observed in CD4(+) cell subsets and signal
joint T cell receptor excision circles (sjTRECs), although
HIV-infected persons had inverted ratios of CD4(+) cells to
CD8(+) cells because they had higher CD8(+) T cell counts,
compared with HIV-uninfected persons. After ASCT, this inversion
was also observed in HIV-uninfected patients up to 24 months.
CD4(+) cell subsets had similar recoveries, with a temporary
setback in HIV-infected persons 3 months after reinfusion,
together with an increase in infections. sjTRECs demonstrated
similar dynamics in both populations and serve as a useful
predictive marker of recovery of CD4(+) cell subsets. No
significant changes emerged in HIV DNA levels during the
follow-up period, with values at 24 months significantly lower
than those at baseline. CONCLUSIONS: Our study demonstrated that
ASCT in HIV-infected persons with lymphoma does not worsen the
initial immune impairment and does not enhance viral replication
or the peripheral HIV reservoir in the long term.
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