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How I treat patients with HIV-related hematological malignancies using hematopoietic cell transplantation

Joseph C. Alvarnas, John A. Zaia and Stephen J. Forman

Abstract

Hematopoietic cell transplantation (HCT) has now been shown to be safe and effective for selected HIV-infected patients with hematological malignancies. Autologous HCT is now standard of care for patients with HIV-related lymphomas who otherwise meet standard transplant criteria. Limited data also supports use of allogeneic HCT (alloHCT) in selected HIV-infected patients who meet standard transplant criteria. We recommend enrolling patients on clinical trials that offer access to CCR5Δ32 homozygous donors, if available. HIV-infected patients requiring HCT may also be considered for participation in trials evaluating the activity of gene-modified hematopoietic stem cells in conferring resistance to HIV infection. To be considered for HCT, patients must have HIV infection that is responsive to combination anti-retroviral therapy (cART). Careful planning for the peri-HCT management of the cART can avoid risk of significant drug interactions and development of cART-resistant HIV. In general, we recommend against the use of boosted proteasome inhibitors and non-nucleotide reverse transcriptase inhibitors in the cART regimen, in favor of nucleoside reverse transcriptase inhibitors and integrase inhibitors (without cobicistat). Following HCT, patients must be closely monitored for development of opportunistic infections (OI), such as cytomegalovirus (CMV). Prevention of OI should include prophylactic and pre-emptive antimicrobials.

  • Submitted April 4, 2017.
  • Accepted August 28, 2017.