Efficacy of autologous stem cell transplant in aids-related lymphoma patients

J.L. Diez-Martin, P. Balsalobre, P. Miralles, A. Gomez-Pineda, R. Carrion, I. Buño, S. Resino, E. Conde, J.M. Ribera, D. Serrano, J. Berenguer

Author address: 

On behalf of the Spanish cooperative groups GELTAMO and GESIDA

Abstract: 

High Activity Antiretroviral Therapy (HAART) has improved the outcome of AIDS patients (Pt) allowing to increase treatment intensity of AIDS-related lymphoma (ARL). 14 male ARL Pt (3 HD/11 NHL) entered ASCT programme. Median age: 39.5 years, ECOG was 1st complete remission (CR) (4 Pt), CR1 needing >1 line of therapy (2 Pt), CR1 with IPI>=2 (2 Pt), Burkitt type undertreated in CR1 (2 Pt) and chemosensitive partial remission (PR) (4 Pt). Mobilisation: G-CSF 20mcg/kg/d (7 Pt), G-CSF 10 mcg/kg/d (1 Pt), CTX 1,5 grs/m2 x 1 day plus G-CSF 20mcg/kg/d (3 Pt) and ARA-C 1 gr/m2/12 h x 4 plus G-CSF 5 mcg/kg/d (3 Pt). Collected Stem Cells were stored in isolated chambers at   -80ºC, after programmed criopreservation, (median of 36 days, r:16-69). 3 mobilized Pt (PR 2pt, CR2 1pt) died before ASCT (1Pt VHC disease and 2 Pt ARL progression). ASCT was performed in 11 Pt (8 NHL and 3 HD). Conditioning regimen used were BEAM (10)/BEAC (1). HAART was maintained during mobilisation and ASCT. G-CSF after ASCT started day +12 (7-21) x 6 days (2-32). CD4 cell and viral load (VL) quantification were performed at mobilisation time, ASCT, +3, +6 and +12 months. Results: Median CD34+ cells collected: 4,7 x106/kg (1,8-21,2). Engraftment of PMN>0.5x109/L was 16 days (9-33) and 20 days (11-36) for platelets >20x109/L. 1 PR Pt progressed and died before platelet  engraftment. 1 Pt (CR1 after 2 lines of chemother) became transfusion independent since day +49 with platelet +100 d. Grade II mucositis in 7 of 10 pt, grade II hepatic toxicity in 1 Pt (+21d). Median CD4 were 216/cc at mobilisation time, 172/cc at ASCT,  160/cc at +3 m and recovered to 200/cc +12 m. VL remained undetectable provided HAART was maintained. Conclusions: Stem cells collected in ARL Pt allow to perform ASCT. Mobilization and conditioning programmes did not increase VL, as long as HAART was maintained. ASCT was not associated with an increased intensification related toxicity and opportunistic infections. ASCT shows long term disease free survival in 72% of ARL Pt
2004

abstract No: 

O253

Full conference title: 

30th Annual Meeting of the European Group for Blood and Marrow Transplantation
    • EBMT 2004