Recovery of cellular immunity following chemotherapy for AIDS related non Hodgkin’s lymphoma

Abstract

8582 Background: Late effects of chemotherapy on immunological parameters in AIDS-related systemic NHL have not been described. Methods: 105 consecutive patients were treated with infusional CDE chemotherapy and HAART and 68 survived more than 3 months following the chemotherapy. Their lymphocyte subsets and plasma HIV viral loads were measured at regular intervals for 2 years and values compared to baseline. Results: During chemotherapy, there were statistically significant falls in CD4 (helper T), CD8 (cytotoxic T) and CD19 (B) cell populations but no changes in the CD56 (natural killer) cell population. Amongst the 68 survivors, there were statistically significant increases in CD4, CD8, CD19 and CD56 populations during the first year of follow-up, compared to the values at the start of chemotherapy. The rises were most marked during the first 3 months of follow-up, and the median rise over the first year were +97 cells/mL for CD4, +318 cells/mL for CD8, +137 cells/mL for CD19 and +32 cells/mL for CD56. During the second year of follow-up further statistically significant rises were documented for CD4 and CD19 cell counts but not for CD8 or CD56 cell counts. Data are available for 43 patients at 2 years post chemotherapy and for these patients the median CD4 cell count rose from 165/mL (IQR: 62–252) at the start of chemotherapy to 270/mL (IQR: 174–445) 2 years after completing chemotherapy. At the start of chemotherapy only 27% patients had an undetectable HIV plasma viral load. This value rose to 69% at the completion of chemotherapy, to 79% at 3 months, 81% at 1 year and 90% at 2 years after completing chemotherapy. Much of the initial suppression of HIV viraemia is because 41% of the cohort were antiretroviral naïve and started HAART with their chemotherapy. During 244 years of follow-up following chemotherapy in these 68 survivors, 7 second primary tumours and 8 opportunistic infections were diagnosed. Conclusions: Chemotherapy and concomitant HAART for AIDS-related NHL does not cause prolonged suppression of lymphocyte subsets. These data should provide reassurance regarding the long term immunological consequences of chemotherapy in people with HIV. No significant financial relationships to disclose.