Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

The same but different: autologous hematopoietic stem cell transplantation for patients with lymphoma and HIV infection

Bone Marrow Transplantation volume 44, pages 1–5 (2009)Cite this article

Abstract

In an earlier era, high-dose therapies were thought to be contraindicated in HIV-infected patients. Patients with HIV fared somewhat better with reduced-dose lymphoma therapies and salvage of relapsed patients was rarely possible. With more than a decade of effective antiretroviral therapy, full-dose lymphoma therapies have become standard, and high-dose therapy with autologous hematopoietic stem cell rescue for those who fail frontline therapy or who are judged to have very high risk disease has been pursued with very encouraging results. Transplant-related mortality is less than 5%. With prophylaxis for pneumocystis and herpesvirus infections, deaths due to opportunistic infections are distinctly unusual. Most deaths have been associated with veno-occlusive disease or lymphoma progression. There is no need for quarantine of patients or special isolation procedures. Most patients with responsive lymphoma remain lymphoma free several years after high-dose therapy. CD4+ cell count and HIV load seem not to be adversely affected in the long term. Much like diabetes, HIV infection should be regarded as a problem that requires special attention during high-dose therapy rather than a contraindication to high-dose therapy in patients with lymphoma who would otherwise be judged transplant candidates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Holland HK, Saral R, Rossi JJ, Donnenberg AD, Burns WH, Beschorner WE et al. Allogeneic bone marrow transplantation, zidovudine, and human immunodeficiency virus type 1 (HIV-1) infection. Studies in a patient with non-Hodgkin lymphoma. Ann Intern Med 1989; 111: 973–981.

    Article  CAS  Google Scholar 

  2. Persad GC, Little RF, Grady C . Including persons with HIV infection in cancer clinical trials. J Clin Oncol 2008; 26: 1027–1032.

    Article  Google Scholar 

  3. Pomerantz RJ, Horn DL . Twenty years of therapy for HIV-1 infection. Nat Med 2003; 9: 867–873.

    Article  CAS  Google Scholar 

  4. Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B . Survival with the acquired immunodeficiency syndrome. Experience with 5833 cases in New York City. N Engl J Med 1987; 317: 1297–1302.

    Article  CAS  Google Scholar 

  5. Lima VD, Hogg RS, Harrigan PR, Moore D, Yip B, Wood E et al. Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS 2007; 21: 685.

    Article  Google Scholar 

  6. Shen L, Peterson S, Sedaghat AR, McMahon MA, Callender M, Zhang H et al. Dose–response curve slope sets class-specific limits on inhibitory potential of anti-HIV drugs. Nat Med 2008; 14: 762–766.

    Article  CAS  Google Scholar 

  7. Engels EA, Goedert JJ . Human immunodeficiency virus/acquired immunodeficiency syndrome and cancer: past, present, and future. J Natl Cancer Inst 2005; 97: 407–409.

    Article  Google Scholar 

  8. Biggar RJ, Jaffe ES, Goedert JJ, Chaturvedi A, Pfeiffer R, Engels EA . Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS. Blood 2006; 108: 3786–3791.

    Article  CAS  Google Scholar 

  9. Levine AM . Acquired immunodeficiency syndrome-related lymphoma. Blood 1992; 80: 8–20.

    CAS  PubMed  Google Scholar 

  10. Kaplan LD, Straus DJ, Testa MA, Von Roenn J, Dezube BJ, Cooley TP et al. Low-dose compared with standard-dose m-BACOD chemotherapy for non-Hodgkin's lymphoma associated with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med 1997; 336: 1641–1648.

    Article  CAS  Google Scholar 

  11. Ratner L, Lee J, Tang S, Redden D, Hamzeh F, Herndier B et al. Chemotherapy for human immunodeficiency virus-associated non-Hodgkin's lymphoma in combination with highly active antiretroviral therapy. J Clin Oncol 2001; 19: 2171–2178.

    Article  CAS  Google Scholar 

  12. Sparano JA, Lee S, Chen MG, Nazeer T, Einzig A, Ambinder RF et al. Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma: an Eastern Cooperative Oncology Group Trial (E1494). J Clin Oncol 2004; 22: 1491–1500.

    Article  CAS  Google Scholar 

  13. Spina M, Jaeger U, Sparano JA, Talamini R, Simonelli C, Michieli M et al. Rituximab plus infusional cyclophosphamide, doxorubicin, and etoposide in HIV-associated non-Hodgkin lymphoma: pooled results from 3 phase 2 trials. Blood 2005; 105: 1891–1897.

    Article  CAS  Google Scholar 

  14. Boue F, Gabarre J, Gisselbrecht C, Reynes J, Cheret A, Bonnet F et al. Phase II trial of CHOP plus rituximab in patients with HIV-associated non-Hodgkin's lymphoma. J Clin Oncol 2006; 24: 4123–4128.

    Article  CAS  Google Scholar 

  15. Little RF, Pittaluga S, Grant N, Steinberg SM, Kavlick MF, Mitsuya H et al. Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology. Blood 2003; 101: 4653–4659.

    Article  CAS  Google Scholar 

  16. Kaplan LD, Lee JY, Ambinder RF, Sparano JA, Cesarman E, Chadburn A et al. Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS Malignancies Consortium Trial 010. Blood 2005; 106: 1538–1543.

    Article  CAS  Google Scholar 

  17. Levine AM, Lee J, Kaplan L, Liebes LF, Sparano JA . Efficacy and toxicity of concurrent rituximab plus infusional EPOCH in HIV-associated lymphoma: AIDS Malignancy Consortium Trial 034. J Clin Oncol 2008; 26 (Suppl): 8527.

    Article  Google Scholar 

  18. Re A, Cattaneo C, Michieli M, Casari S, Spina M, Rupolo M et al. High-dose therapy and autologous peripheral-blood stem-cell transplantation as salvage treatment for HIV-associated lymphoma in patients receiving highly active antiretroviral therapy. J Clin Oncol 2003; 21: 4423–4427.

    Article  CAS  Google Scholar 

  19. Gabarre J, Marcelin AG, Azar N, Choquet S, Levy V, Levy Y et al. High-dose therapy plus autologous hematopoietic stem cell transplantation for human immunodeficiency virus (HIV)-related lymphoma: results and impact on HIV disease. Haematologica 2004; 89: 1100–1108.

    PubMed  Google Scholar 

  20. Krishnan A, Molina A, Zaia J, Smith D, Vasquez D, Kogut N et al. Durable remissions with autologous stem cell transplantation for high-risk HIV-associated lymphomas. Blood 2005; 105: 874–878.

    Article  CAS  Google Scholar 

  21. Serrano D, Carrion R, Balsalobre P, Miralles P, Berenguer J, Buno I et al. HIV-associated lymphoma successfully treated with peripheral blood stem cell transplantation. Exp Hematol 2005; 33: 487–494.

    Article  CAS  Google Scholar 

  22. Spitzer TR, Ambinder RF, Lee JY, Kaplan LD, Wachsman W, Straus DJ et al. Dose-reduced busulfan, cyclophosphamide, and autologous stem cell transplantation for human immunodeficiency virus-associated lymphoma: AIDS Malignancy Consortium Study 020. Biol Blood Marrow Transplant 2008; 14: 59–66.

    Article  CAS  Google Scholar 

  23. Nagamura F, Takahashi T, Takeuchi M, Iseki T, Ooi J, Tomonari A et al. Effect of cyclophosphamide on serum cyclosporine levels at the conditioning of hematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 32: 1051–1058.

    Article  CAS  Google Scholar 

  24. Robertson SM, Penzak SR, Pau A . Drug interactions in the management of HIV infection: an update. Expert Opin Pharmacother 2007; 8: 2947–2963.

    Article  CAS  Google Scholar 

  25. Taylor S, Boffito M, Khoo S, Smit E, Back D . Stopping antiretroviral therapy. AIDS 2007; 21: 1673–1682.

    Article  Google Scholar 

  26. Flexner C . HIV drug development: the next 25 years. Nat Rev 2007; 6: 959–966.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    R F Ambinder

Authors
  1. R F Ambinder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R F Ambinder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ambinder, R. The same but different: autologous hematopoietic stem cell transplantation for patients with lymphoma and HIV infection. Bone Marrow Transplant 44, 1–5 (2009). https://doi.org/10.1038/bmt.2009.105

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.105

Keywords

This article is cited by

Search

Advanced search

Quick links