Autologous hematopoietic cell transplantation for HIV-related lymphoma: Results of the BMT CTN 0803/AMC 071 trial

Joseph C. Alvarnas, Jennifer Le Rademacher, Yanli Wang, Richard F. Little, Gorgun Akpek, Ernesto Ayala, Steven Devine, Robert Baiocchi, Gerard Lozanski, Lawrence Kaplan, Ariela Noy, Uday Popat, Jack Hsu, Lawrence E. Morris, Jason Thompson, Mary M. Horowitz, Adam Mendizabal, Alexandra Levine, Amrita Krishnan, Stephen J. FormanWillis H. Navarro, Richard Ambinder

Research output: Contribution to journalArticle

Abstract

Autologous hematopoietic cell transplant (AHCT) for HIV-infected patients is largely limited to centers with HIV-specific expertise. The Blood and Marrow Transplant Clinical Trials Network 0803/AIDS Malignancy Consortium 071 trial is a multicenter phase 2 study of AHCT for patients with HIV-related lymphoma (HRL). Eligible patients had chemotherapy-sensitive relapsed/persistent HRL, were >15 years of age, and had treatable HIV infection. Patients were prepared using carmustine, etoposide, cytarabine, and melphalan and received consistent management of peritransplant antiretroviral treatment. The primary endpoint was 1-year overall survival. Forty-three patients were enrolled; 40 underwent AHCT. Pretransplant HIV viral load was undetectable (<50 copies/mL) in 32 patients (80%); the median CD4 count was 249/μL (range, 39-797). At a median follow-up-of 24.8 months, 1-year and 2-year overall survival probabilities were 87.3% (95% confidence interval [CI], 72.1-94.5) and 82% (95% CI, 65.9-91), respectively. The probability of 2-year progression-free survival was 79.8% (95% CI, 63.7-89.4). One-year transplant-related mortality was 5.2%. Median time to neutrophil and platelet recovery was 11 days and 18 days, respectively. Nine patients experienced a total of 13 unexpected grade 3-5 adverse events posttransplant (10 grade 3 and 3 grade 4 events). Twenty-two patients had atleast 1 infectious episode posttransplant. At 1 year post-AHCT, median CD4+T-cellcount was 280.3 (range, 28.8-1148.0);82.6% had an undetectable HIV viral load. Trial patients were compared with 151 matched Center for International Bone Marrow Transplant Research controls. Outcomes between HIV-infected patients and controls were not statistically significantly different. HRL patients should be considered candidates for AHCT if they meet standard transplant criteria.

Original languageEnglish (US)
Pages (from-to)1050-1058
Number of pages9
JournalBlood
Volume128
Issue number8
DOIs
StatePublished - Aug 25 2016

Keywords

  • Autologous hematopoietic cell transplantation is safe and effective in patients with HIV-related lymphoma who meet standard transplant criteria.
  • Patients with HIV-related lymphomas should not be precluded from participating in AHCT clinical trials

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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  • Cite this

    Alvarnas, J. C., Le Rademacher, J., Wang, Y., Little, R. F., Akpek, G., Ayala, E., Devine, S., Baiocchi, R., Lozanski, G., Kaplan, L., Noy, A., Popat, U., Hsu, J., Morris, L. E., Thompson, J., Horowitz, M. M., Mendizabal, A., Levine, A., Krishnan, A., ... Ambinder, R. (2016). Autologous hematopoietic cell transplantation for HIV-related lymphoma: Results of the BMT CTN 0803/AMC 071 trial. Blood, 128(8), 1050-1058. https://doi.org/10.1182/blood-2015-08-664706