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Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the (BMT CTN) 0803/(AMC) 071 Trial

Joseph C. Alvarnas, Jennifer Le Rademacher, Yanli Wang, Richard F. Little, Gorgun Akpek, Ernesto Ayala, Steven Devine, Robert Baiocchi, Gerard Lozanski, Lawrence Kaplan, Ariela Noy, Uday Popat, Jack Hsu, Lawrence E. Morris Jr., Jason Thompson, Mary H. Horowitz, Adam Mendizabal, Alexandra Levine, Amrita Krishnan, Stephen J. Forman, Willis H. Navarro and Richard F. Ambinder

Key points

  • Autologous hematopoietic cell transplantation is safe and effective in patients with HIV-related lymphoma who meet standard transplant criteria.

  • Patients with HIV-related lymphomas should not be precluded participating in autologous hematopoietic cell transplant clinic trials.

Abstract

Autologous hematopoietic cell transplant (AHCT) for HIV-infected patients is largely limited to centers with HIV-specific expertise. The BMT CTN 0803/AMC 071 trial is a multicenter phase II study of AHCT for patients with HIV-related lymphoma (HRL). Eligible patients had chemotherapy-sensitive relapsed/persistent HRL, were > 15 years of age, and had treatable HIV infection. Patients were prepared using BEAM (carmustine, etoposide, cytarabine, melphalan) and received consistent management of peri-transplant antiretroviral treatment. The primary endpoint was one-year overall survival (OS). Forty-three patients were enrolled; 40 underwent AHCT. Pre-transplant HIV viral load was undetectable (<50 copies/mL) in 32 patients 80%); the median CD4 count was 249/µL (range 39 - 797). At a median follow-up 24.8 months, one-year and two-year OS probabilities were 87.3% (95% confidence interval (CI): 72.1% - 94. 5%) and 82% (95% CI: 65.9% - 91%), respectively. The probability of two-year progression-free survival was 79.8% (95% CI: 63.7% - 89.4%). One-year transplant-related mortality (TRM) was 5.2%. Median time to neutrophil and platelet recovery was 11 days and 18 days, respectively. Fifteen patients developed > grade 3 toxicities within one-year post-AHCT (grade 4 in 2, grade 3 in 13). Seventeen patients had at least one infectious episode post-transplant. At one year post-AHCT, median CD4+ T-cell count was 280 (range 28.8 - 1148.0); 82.6% had an undetectable HIV viral load. Trial patients were compared to 151 matched CIBMTR controls. Outcomes between HIV-infected patients and controls were not statistically significantly different. HRL patients should be considered candidates for AHCT if they meet standard transplant criteria. The trial is registered to www.clinicaltrials.gov as NCT01141712.

  • Submitted August 25, 2015.
  • Accepted April 8, 2016.