Abstract
AbstractThe treatment of HIV-associated lymphoma has changed since the widespread use of highly active antiretroviral therapy. HIV-infected individuals can tolerate more intensive chemotherapy, as they have better hematologic reserves and fewer infections. This has led to higher response rates in patients with HIV-associated Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL) treated with chemotherapy in conjunction with antiretroviral therapy. However, for patients with refractory or relapsed disease, salvage chemotherapy still offers little chance of long-term survival. In the non-HIV setting, patients with relapsed Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL) have a better chance of long-term remission with high-dose chemotherapy with autologous stem cell rescue (ASCT) compared with conventional salvage chemotherapy. In a prior report we demonstrated that this approach is well tolerated in patients with underlying immunodeficiency from HIV infection. Furthermore, similar engraftment to the non-HIV setting and low infectious risks have been observed. Herein, we expand upon this early experience with the largest single institution series of 20 patients. With long-term follow-up we demonstrate that ASCT can lead to an 85% progression-free survival, which suggests that this approach may be potentially curative in select patients with relapsed HIV-associated HD or NHL.
Highlights
The incidence of Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) in HIV-infected individuals is much greater than in the HIV-negative population.[1,2] In earlier decades the treatment of lymphoma in the setting of immune deficiency was far less successful than in the HIV-negative patient.[3]
Recent studies have confirmed that the International Prognostic Index (IPI) is applicable to patients treated with highly active antiretroviral therapy (HAART) and chemotherapy.[7]
Patients received a median of 2 chemotherapy regimens prior to autologous stem cell transplant (ASCT)
Summary
The incidence of Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) in HIV-infected individuals is much greater than in the HIV-negative population.[1,2] In earlier decades the treatment of lymphoma in the setting of immune deficiency was far less successful than in the HIV-negative patient.[3]. Our initial experience demonstrated the feasibility of this approach in terms of stem cell mobilization, engraftment, and low regimen-related toxicity.[16] with long-term follow-up in a larger series of patients we demonstrate that ASCT can provide durable remissions in a subset of these high-risk patients.
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