Nav: Home

Study: Autologous stem cell transplant should be standard care for HIV-associated lymphoma

June 13, 2016

(WASHINGTON -June 13, 2016) - New research published online today in Blood Journal of the American Society of Hematology (ASH), challenges the generally held belief that individuals with HIV and aggressive lymphoma are not candidates for standard treatment.

According to researchers, people with HIV-associated lymphoma who receive autologous stem cell transplant have similar survival rates and are no more at risk of serious complications compared to those without HIV receiving this therapy.

People living with human immunodeficiency virus, or HIV--even those whose infection is well controlled with modern combination antiretroviral therapy--remain at significant risk of cancer. The risk of non-Hodgkin lymphoma alone is up to 25-fold greater for people with HIV than for those without the infection, and malignancies have quickly become a leading cause of death as people with HIV live longer.

Autologous hematopoietic cell transplant (AHCT)--a procedure in which healthy cells are taken from the patient's own blood or bone marrow and administered to help them recover after high-dose chemotherapy--has become the standard of care for treating relapsed and treatment-resistant Hodgkin and non-Hodgkin lymphoma; however, its use in HIV-infected patients is largely limited to centers with HIV-specific expertise.

Clinicians have historically been hesitant to treat HIV patients with stem cell transplant due to concerns that their immune systems would not effectively recover after intensive chemotherapy or that the procedure would cause excessive toxicities or infections post-transplant. However, in this Phase II clinical trial, designed to prospectively evaluate the safety and effectiveness of ACHT for patients with HIV-related lymphoma, researchers discovered that this population had no greater likelihood of developing these complications compared to those without the virus.

"Overall survival for patients with HIV infection after transplant is comparable to that seen in people who were not HIV-infected," said lead author Joseph Alvarnas, MD, associate clinical professor in the department of hematology and director of value-based analytics at the City of Hope National Medical Center in Duarte, CA.

The data also show that transplant-related toxicities in these patients are comparable to those observed in patients without HIV.

"These findings are remarkably important for a group of patients who, up until now, have been inconsistently treated," Dr. Alvarnas said. "Transplantation allows clinicians to treat the cancer most effectively by using more intense doses of chemotherapy than can typically be given, while avoiding fears of wiping out the bone marrow. Based on our data, autologous stem cell transplant should be considered the standard of care for patients with HIV-related lymphomas for the same indications and under the same circumstances that we would use it in patients without HIV infection."

In this study, prior to giving intensive BEAM chemotherapy (which uses carmustine, etoposide, cytarabine, and melphalan), researchers collected stem cells from each patient's blood. These stem cells are frozen and then later administered to the patient intravenously to rescue the patient after therapy.

A total of 43 patients with treatable HIV infection who had chemotherapy-sensitive relapsed/treatment-resistant non-Hodgkin or Hodgkin lymphoma were enrolled in this trial between April 2010 and March 2013; 40 received AHCT at 16 centers. Three patients did not receive a transplant due to disease progression. Patients underwent frequent lab testing and received supportive care post-AHCT based on institutional standards. Disease status was assessed before AHCT, at day 100, and at one year post-transplantation. Researchers then compared patients in the trial to 151 similar patients who did not have HIV but received the same treatment for their lymphoma using data reported to the Center for International Blood & Marrow Transplant Research (CIBMTR).

After a median follow-up of 25 months, overall survival at one year and two years post-transplant was 87.3 and 82 percent, respectively. This was comparable to those without HIV, whose overall survival at one year was 87.7 percent. The probability of two-year progression-free survival among those with HIV was 79.8 percent. One-year transplant-related death was 5.2 percent and resulted from recurrence/persistence of the lymphoma, fungal infection, and cardiac arrest, which was comparable to the non-HIV patients. Median time to white blood cell and platelet recovery was 11 and 18 days, respectively. Within one year of AHCT, 15 patients developed severe toxicities and 17 had at least one infection. Moreover, patients with HIV infection remained in good control over their disease post-transplant; most patients (82 percent) still had undetectable levels of the virus after one year.

"When you look at people's recovery - recovery of their T-cells and CD4+ and suppression of viral load - we don't see people losing control of HIV infection, nor do they have evidence of additional immunological deficits following transplant. I think that's very reassuring," said Dr. Alvarnas, who adds the trial was sufficiently powered to make these conclusions.

Historically, it has also been a challenge to manage antiretroviral therapy in patients undergoing chemotherapy due to potential drug-drug interactions. According to the author, this study is unique in that researchers used a consistent algorithm for treating HIV infection, including avoiding certain drugs and having a planned interruption in antiretroviral therapy that took place from initiation of chemotherapy until completion of the preparative regimen or following recovery from transplant-related gastrointestinal toxicities (roughly one week).

"This is an important study because we need to better understand the long-term effects of HIV infection to ensure that patients are equitably treated in a way that respects their medical regimens and the biology of their HIV infection," he said.

Clinical trial research is also ongoing to evaluate the safety of allogeneic hematopoietic cell transplantation--using cells taken from healthy donor tissue--for HIV-infected patients with blood cancers.
-end-
The trial (BMT CTN 0803/AMC 071) was funded by the Blood and Marrow Transplant Clinical Trials Network and the AIDS Malignancy Consortium working in collaboration with the National Heart, Lung, and Blood Institute and the National Cancer Institute.

Blood, the most cited peer-reviewed publication in the field of hematology, is available weekly in print and online. Blood is the official journal of the American Society of Hematology (ASH), the world's largest professional society concerned with the causes and treatment of blood disorders.

ASH's mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems by promoting research, clinical care, education, training, and advocacy in hematology.

blood® is a registered trademark of the American Society of Hematology. Follow @BloodJournal on Twitter.

American Society of Hematology

Related Stem Cells Articles:

Computer simulations visualize how DNA is recognized to convert cells into stem cells
Researchers of the Hubrecht Institute (KNAW - The Netherlands) and the Max Planck Institute in Münster (Germany) have revealed how an essential protein helps to activate genomic DNA during the conversion of regular adult human cells into stem cells.
First events in stem cells becoming specialized cells needed for organ development
Cell biologists at the University of Toronto shed light on the very first step stem cells go through to turn into the specialized cells that make up organs.
Surprising research result: All immature cells can develop into stem cells
New sensational study conducted at the University of Copenhagen disproves traditional knowledge of stem cell development.
The development of brain stem cells into new nerve cells and why this can lead to cancer
Stem cells are true Jacks-of-all-trades of our bodies, as they can turn into the many different cell types of all organs.
Healthy blood stem cells have as many DNA mutations as leukemic cells
Researchers from the Princess Máxima Center for Pediatric Oncology have shown that the number of mutations in healthy and leukemic blood stem cells does not differ.
New method grows brain cells from stem cells quickly and efficiently
Researchers at Lund University in Sweden have developed a faster method to generate functional brain cells, called astrocytes, from embryonic stem cells.
NUS researchers confine mature cells to turn them into stem cells
Recent research led by Professor G.V. Shivashankar of the Mechanobiology Institute at the National University of Singapore and the FIRC Institute of Molecular Oncology in Italy, has revealed that mature cells can be reprogrammed into re-deployable stem cells without direct genetic modification -- by confining them to a defined geometric space for an extended period of time.
Researchers develop a new method for turning skin cells into pluripotent stem cells
Researchers at the University of Helsinki, Finland, and Karolinska Institutet, Sweden, have for the first time succeeded in converting human skin cells into pluripotent stem cells by activating the cell's own genes.
In mice, stem cells seem to work in fighting obesity! What about stem cells in humans?
This release aims to summarize the available literature in regard to the effect of Mesenchymal Stem Cells transplantation on obesity and related comorbidities from the animal model.
TSRI researchers identify gene responsible for mesenchymal stem cells' stem-ness'
Researchers at The Scripps Research Institute recently published a study in the journal Cell Death and Differentiation identifying factors crucial to mesenchymal stem cell differentiation, providing insight into how these cells should be studied for clinical purposes.
More Stem Cells News and Stem Cells Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.