892MO High-dose chemotherapy with autologous hematopoietic stem cell transplantation in patients with HIV-related lymphoma

Abstract

The number of prospective matched case-controlled studies to prove the safety and efficacy of autologous stem cell transplantation (ASCT) in HIV-related lymphoma is limited. Between January 2016 and January 2020, twelve patients with HIV-related lymphoma who have undergone ASCT were included in this prospective matched case-control study (study group, n=12). Forty eight non-HIV-infected patients were enrolled to the control group (n=48, 1:4). The median age was 34 (19-66) y.o. The underlying diseases in the study group were Hodgkin lymphoma (HL) n=7 (58,3%) and non-Hodgkin lymphoma (NHL) n=5 (41,7%), complete remission at the moment of ASCT – 66,7%. Conditioning regimen was BEAM with BCNU replacement by Bendamustine 160 mg/m2/day at D-7, D-6. HIV viral load was undetectable; the median number of CD4+ cells was 471,5 (210-715) cells/mcl; all patients were on anti-retroviral therapy (ART). The median follow up time was 16 (1-43) months. The 2-year overall survival (OS) (n=60) was 90%; 91,7% in the study group and 89,9% in the control group, and this was not significantly different between the groups (P= 0,763). Progression-free survival (PFS) at 2 years in the study group was 75%, and was not significantly different to the control group (70,8%; P=0,777). Time to progression (TTP) at 2 years was 14,6% in the study group and 16,7% in the control group (P=0,643). Complete remission at the moment of ASCT improved PFS (P =0,03) and TTP (P =0,044) in the whole group. The median time for recovery of leukocytes, neutrophils, and platelets was D+14,5 (10-25), D+17 (12-30), D+15,5 (11-31), respectively, in the study group and D+14 (10-22), D+15 (10-23), D+15 (8-31) in the control group. Neutrophil recovery was significantly delayed in study group (P=0,04). There was no difference in the rate of organ toxicity according to CTCAE. The transplant-related mortality (TRM) at 2 years was 8,3% in the study group and 6,2% in the control group (P=0,8). Two-year overall survival in patients with HIV-related lymphoma was 91.7%, PFS was 75%, TTP was 14,6% and TRM was 8,3% and did not differ significantly from the control group. Only neutrophil recovery was significantly delayed after ASCT in patients with HIV-related lymphoma. Our data provide further evidence that ASCT is a safe and effective approach for patients with HIV-related lymphoma.