Although a number of patients with HIV infection and hematological disease have successfully undergone allogeneic hematopoietic stem cell transplantation (HSCT), short and long-term outcomes remain not well known. We report the largest Spanish experience treating HIV-infected adult patients with high-risk hematological malignancies with allogeneic HSCT.
We retrospectively reviewed 22 HIV-positive patients who received allogeneic HSCT in 5 centers in Spain.
22 patients with high-risk hematological malignancies were transplanted between 1999 and 2018. Median age was 44 years. With a median follow-up of 65 months (8–112), OS and EFS were 46%. NRM was 14% at 12 months and relapse was 24% at 24 months. Grade II-IV aGvHD rate was 40%, and moderate/severe cGvHD rate was 41% at 24 months. All patients received cART. Two patients showed severe toxicity related to drug interaction with anti-retroviral therapy. 68% of patients showed infectious complications with viral infections as the most frequent cause. Two patients had invasive aspergillosis and one patient presented disseminated tuberculosis. All survivors except one maintained undetectable HIV load at last follow-up after HSCT.
Allogeneic HSCT is an effective therapy for high-risk hematological malignancies in patients with HIV infection, and long-term HIV suppression with cART is feasible. However, drug interactions with anti-retroviral agents, occurrence of GVHD, and frequent infectious complications account for a complex procedure in this population. Selected HIV-infected patients with hematologic malignancies should be considered for allo-HSCT when indicated, in experienced centers.
aDepartment of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
bGregorio Marañón Health Research Institute, Madrid, Spain
cDepartment of Hematology, Hospital Universitario Virgen de las Nieves, Granada, Spain
dDepartment of Hematology, Hospital Marqués de Valdecilla, Santander, Spain
eDepartment of Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
fDepartment of Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
gDepartment of Hematology, Hospital Universitario y Politécnico de la Fe, Valencia, Spain
hUniversidad Complutense de Madrid, Madrid, Spain.
Correspondence to Mi Kwon, MD, Department of Hematology, Hospital G. Univ. Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain. Tel: +34 915868443; fax: +34 915868394; e-mail: firstname.lastname@example.org
Received 28 July, 2018
Revised 23 December, 2018
Accepted 15 January, 2019