Background: The use of HAART has improved the outcome of patients (pts) with AIDS-related Lymphoma (ARL)and has allowed for an increase in the intensity of treatment. We describe the results of Autologous Hematopoietic Stem Cell Transplantation (ASCT) in 6 pts with ARL.

Methods: During the last 2 yr, 8 pts with ARL underwent mobilization and collection of hematopoietic stem cells (HSC). Two (2) mobilized pts died before ASCT (liver disease = 1, and progression of ARL = 1). ASCT was performed in 6 pts (NHL = 4 and HD = 2). All 6 were in complete remission (CR) at the time of the procedure (table). Indications for ASCT were: not achieving a CR after the 1^st line of therapy (2), high risk histology—Burkitt’s Lymphoma (2), and relapse (2). HSC were mobilized with G-CSF (20 mcg/kg/d) with or without cyclophosphamide. The conditioning regimen was BEAM. G-CSF was administered after ASCT. HAART was maintained during mobilization and ASCT, except during conditioning in pt #1.

Results: The median number of HSC collected was 4.6 x 10⁶/Kg. The median time to reach > 500 PMNs/uL and > 20K platelets/uL after conditioning were 19.5 d and 20 d respectively. Complications following ASCT: 5 pts had neutropenia-related infections (fever 2, bacteremia 2, and pneumonia 1), mucositis 3 pts , grade 4 hepatotoxicity 1 pt, herpes-zoster 1 pt. All 6 pts are alive and in CR after a median follow-up time of 17 months (mos).

Baseline

3 mo

6 mo

12 mo

#

Age

HAART

ARL

Indication

CD4

VL

CD4

VL

CD4

VL

CD4

VL

Follow-up

1

35

2NA+1PI

HD

2nd CR

210

< 50

280

6K

176

15K

220

< 50

Alive/CR/28 mos

2

38

2NA+1NN

NHL

2nd RX

115

< 50

250

< 50

260

< 50

490

< 50

Alive/CR/20 mos

3

58

3NA+1NN

NHL

Burkitt’s ARL

195

221

184

352

180

3K

142

69K

Alive/CR/17 mos

4

54

2NA+1NN

NHL

2nd RX

120

< 50

133

< 50

154

< 50

200

< 50

Alive/CR/17 mos

5

31

2NA+1NN

NHL

Burkitt’s ARL

48

130K

61

40K

128

113

440

< 50

Alive/CR/16 mos

6

54

2NA+1NN

HD

2nd CR

230

< 50

NA

NA

NA

NA

NA

NA

Alive/CR/1 mos

NA not available. CD4: CD4⁺ cells/uL. VL: HIV viral load (copies/mL), 2^nd RX: CR after a 2nd line of chemotherapy

 

Conclusions

In pts with ARL, an adequate number of HSC can be obtained following mobilization, although engraftment appears to be slower than in HIV^- pts. This supports the use of hematopoietic growth factors. HAART can be safely maintained during mobilization and conditioning. The ASCT is not associated with increased opportunistic infections. Our findings suggest that ASCT may be applied with guarantees in Pt with ARL.