Long-Term Clinical Outcomes After Autologous Hematopoietic Stem Cell Transplantation in 49 Individuals Living With HIV (PLWH) and Affected by High-Risk or Relapsed Lymphoma: A European Experience of Continued Relevance for PLWH.

in Journal of medical virology by Ernesto Zanet, Martina Taborelli, Umberto Tirelli, Jose Diez-Martin, Pascual Balsalobre, Alessandro Re, Maurizio Rupolo, Mario Mazzucato, Kate Cwynarski, Maria Rosario Varela Gomez, Gaelle Guillerm, Diego Serraino, Rosanna Ciancia, Salvatore Chirumbolo, Antonino Carbone, Mariagrazia Michieli

TLDR

  • The study found that ASCT is effective in managing opportunistic infections but highlights the need for ongoing immune recovery monitoring to predict and prevent late-onset complications in PLWH treated with ASCT for lymphoma.
  • The study's findings emphasize the importance of developing specific tests to predict risk and guide effective interventions for metabolic diseases, secondary malignancies, and lymphoma relapses in PLWH treated with ASCT for lymphoma.

Abstract

Previous reports have indicated that during the era of combination antiretroviral therapy, the major causes of morbidity and mortality in people living with HIV (PLWH) were not solely linked to HIV-related opportunistic infections but also to cancers that were difficult to manage due to HIV-related immunodeficiency. We investigated whether PLWH who underwent autologous hematopoietic stem cell transplantation (ASCT) for lymphomas experienced significant morbidity over the past thirty years following HIV infection. We conducted a retrospective follow-up study of 49 PLWH over a 10-year period following ASCT. We collected survival data, examined the occurrence of long-term events, assessed CD4 + T-cell immune recovery, and analysed the correlation between immune recovery and the events experienced by these patients. The data confirmed the significant long-term effectiveness of ASCT, with an overall survival rate of 78% at 10 years post-ASCT. Opportunistic infections, which occurred soon after ASCT and were associated with lower CD4 + T-cell counts, were successfully managed. However, lymphoma relapse, secondary malignancies, cardiovascular disease, and bone disease, which developed years after ASCT, were major causes of morbidity and mortality in this population. Our findings highlight the need for the development and validation of specific tests to predict risk and guide effective interventions for metabolic diseases, secondary malignancies, and lymphoma relapses in PLWH treated with ASCT for lymphoma.

Overview

  • The study investigated the long-term outcome of people living with HIV (PLWH) who underwent autologous hematopoietic stem cell transplantation (ASCT) for lymphomas over the past 30 years following HIV infection.
  • The study aims to examine the survival rate, occurrence of long-term events, CD4 + T-cell immune recovery, and correlation between immune recovery and events experienced by these patients.
  • The primary objective is to determine the effectiveness of ASCT and identify specific tests to predict risk and guide interventions for metabolic diseases, secondary malignancies, and lymphoma relapses in PLWH treated with ASCT for lymphoma.

Comparative Analysis & Findings

  • The study found that ASCT was effective in managing opportunistic infections that occurred soon after transplantation, but lymphoma relapse, secondary malignancies, cardiovascular disease, and bone disease developed years after ASCT and were major causes of morbidity and mortality.
  • The overall survival rate at 10 years post-ASCT was 78%, indicating the long-term effectiveness of ASCT.
  • CD4+ T-cell immune recovery was associated with a reduced risk of long-term events, highlighting the need for ongoing immune recovery monitoring to guide clinical interventions.

Implications and Future Directions

  • The study highlights the need for the development and validation of specific tests to predict risk and guide effective interventions for metabolic diseases, secondary malignancies, and lymphoma relapses in PLWH treated with ASCT for lymphoma.
  • Future research should focus on identifying biomarkers to predict and prevent late-onset complications and develop personalized treatment strategies to improve patient outcomes.
  • Regular monitoring of immune recovery and early detection of potential complications are crucial to minimize the burden of morbidity and mortality in PLWH treated with ASCT for lymphoma.
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