December 8, 2014 | by Nicole White
Patients with HIV-associated lymphoma may soon have increased access to the current standard of care for some non-HIV infected patients – autologous stem cell transplants.
Impressive new data, presented Monday at the annual meeting of the American Society of Hematology (ASH) in San Francisco, indicate that HIV-associated lymphoma patients who meet standard eligibility criteria for transplants of their own stem cells respond well to the treatment, even in centers that do not have HIV-specific expertise. HIV infection has historically been viewed as reason to rule out autologous stem cell transplant – the standard of care for non-infected patients with relapsed or treatment-resistant lymphoma – due to their compromised immune system.
The new study could change that perception. It was led by Joseph Alvarnas, M.D., director of Medical Quality and Quality, Risk and Regulatory Management and a physician investigator at the Hematologic Malignancies and Stem Cell Transplantation Institute at City of Hope, and colleagues at Johns Hopkins Hospital. The study builds on previous research at City of Hope, including a crucial 2001 publication that was among the first internationally to show these transplants were possible for HIV patients.
“My colleagues at City of Hope have been true pioneers in this field of study,” Alvarnas said. “This broader trial shows that not only can these transplants be done in HIV patients, but that it is a viable therapy for HIV-associated lymphoma. Ultimately, these results argue persuasively that HIV or AIDS status should not be a barrier to autologous stem cell transplant for patients who meet standard eligibility criteria.”
The new study found the transplants to be effective, tolerable and not overly toxic for patients with HIV-associated lymphoma. Patients in the clinical trial received autologous stem cell transplants with a high-dose preparative regimen of chemotherapy, and achieved survival rates comparable to other lymphoma patients. After a median two-year follow-up, the one-year survival rate among the 40 HIV lymphoma patients in the clinical trial who received stem cell transplantation was 86.6 percent. The trial also estimated a one-year progression-free survival rate of 82.3 percent – remarkable as all of these patients had lymphoma that did not respond to prior therapy.
HIV-positive people are 70 times more likely to be diagnosed with lymphoma than uninfected people. Historically, because of their badly compromised immune systems, most HIV patients could not tolerate standard treatments for lymphoma. However, as anti-retroviral therapies have improved, HIV patients with lymphoma have had access to medications and other therapies offered to lymphoma patients not infected with HIV. Because they are immunocompromised, they have been considered ineligible for autologous stem cell transplants, in which patients are infused with their own stem cells. This has put HIV lymphoma patients at a disadvantage.
City of Hope physician scientists, led by Amrita Krishnan, M.D.,, director of the Multiple Myeloma Program, were among the first in the world to publish research showing autologous stem cell transplants are feasible for selected HIV lymphoma patients in a widely cited study in Blood.
“What makes the current clinical trial so useful is we offered something previously done only in centers with very specific expertise and showed it could be extended to multiple centers – even those that did not specialize in HIV,” Alvarnas said.
Funding for the study, part of the Bone Marrow Transplant Clinical Trials Network, was provided by the National Cancer Institute. The study was part of a Cancer Therapy Evaluation Program effort to expand clinical trial access to HIV-infected patients with cancer.
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