Patients with HIV-associated lymphoma have long been thought of as poor candidates for the standard treatment for the disease. According to a new study however, these patients have similar survival rates and face comparable risks when treated with an autologous stem cell transplant, compared to HIV-negative individuals with lymphoma.
Despite advances in antiretroviral therapies and disease management, individuals with HIV face a significantly higher risk of developing cancer. In particular, HIV-positive patients are up to 25 percent more likely to develop non-Hodgkin’s lymphoma, compared to the general population.
A procedure known as autologous hematopoietic cell transplant – in which healthy cells are collected from a patient’s blood and reinfused following high doses of chemotherapy – is considered to be the standard of care for patients with relapsed forms of non-Hodgkin’s lymphoma. Unfortunately, physicians are often reluctant to apply this treatment to patients with HIV, due to concerns that the stem cell transplant could cause excessive toxicities.
A recent Phase II clinical trial found that HIV-positive patients were no more at likely to develop complications following the stem cell transplant, than patients not infected with the virus. The research was published in Blood, the Journal of the American Society of Hematology.
“Overall survival for patients with HIV infection after transplant is comparable to that seen in people who were not HIV-infected,” said Dr. Joseph Alvarnas, associate clinical professor in the department of hematology and director of value-based analytics at the City of Hope National Medical Center in California. Transplant-related toxicities in HIV patients were also found to be equivalent to uninfected cancer patients.
“These findings are remarkably important for a group of patients who, up until now, have been inconsistently treated,” said Alvarnas. “Transplantation allows clinicians to treat the cancer most effectively by using more intense doses of chemotherapy than can typically be given, while avoiding fears of wiping out the bone marrow. Based on our data, autologous stem cell transplant should be considered the standard of care for patients with HIV-related lymphomas for the same indications and under the same circumstances that we would use it in patients without HIV infection.”
The clinical trial involved 43 patients with treatable HIV infection who also had relapsed or treatment-resistant non-Hodgkin’s or Hodgkin’s lymphoma. The researchers collected stem cells from the trial participants prior to their receiving intensive chemotherapy. These cells were later infused back into the patient to support post-treatment recovery. Using data reported to the Center for International Blood & Marrow Transplant Research, the researchers compared the treatment outcomes for the HIV patients with those from 151 HIV-negative patients who received the same autologous hematopoietic cell transplant following chemotherapy.
At one year post-transplant, the HIV group showed an overall survival rate of 87.3. Similarly, the overall survival rate for those without HIV was comparable at 87.7 percent. The transplant-related death rate was 5.2 percent at one year post-transplant, which was also comparable to non-HIV patients.
“When you look at people’s recovery – recovery of their T-cells and CD4+ and suppression of viral load – we don’t see people losing control of HIV infection, nor do they have evidence of additional immunological deficits following transplant. I think that’s very reassuring,” said Alvarnas. “This is an important study because we need to better understand the long-term effects of HIV infection to ensure that patients are equitably treated in a way that respects their medical regimens and the biology of their HIV infection.”