Abstract 4355

Little is known about the additional benefit of Autologous Stem Cell Transplantation (ASCT) as consolidation treatment of NHL in 1st CR in HIV+ patients. We herein report a comparative analysis of HIV+ patients with a LBCL treated with chemotherapy (chemo) followed by ASCT and a matched cohort of HIV+ patients treated with chemo alone.

Methodology

Retrospective, registry-based, matched cohort study. ASCT cohort: patients with diffuse large B-cell (DLBC) or plasmablastic NHL treated with ASCT in 1st CR after standard chemo and reported to the EBMT Registry. Chemo cohort: For each patient within the ASCT cohort we selected two controls from the HIV+ patients with NHL GESIDA/PETHEMA registry. Patients in both cohorts were in 1st CR following front-line or rescue (for partially responding patients) chemo and were matched according to histology, IPI and the use of Rituximab. We compared overall survival (OS), disease free survival (DFS) and cumulative incidence (CI) of relapse between both cohorts. These primary outcomes were defined according to the EBMT. OS was computed from diagnosis while DFS and CI of relapse were computed from 3 weeks after the last standard chemo cycle administered (end of chemo).

Results

The ASCT cohort included 10 patients diagnosed between 1999 and 2005. The Chemo cohort included 20 patients, 16 diagnosed between 1999 and 2005. Both cohorts were comparable for the main clinical and patient features (Table 1). The median (range) follow-up (FU) time since the end of chemo for surviving patients was 56 months (mo) (24-106) in the ASCT cohort vs 37 mo (8-107.5) in the Chemo cohort; P=.28. Five years (yr) OS for the ASCT cohort and the Chemo cohort were 68.5% [CI95%: 39-98] and 46.5% [CI95%: 18-75], respectively; P=.6. Three yr DFS for the ASCT cohort and the Chemo cohort were 70% [CI95%: 41.5-98.5] and 59.5% [CI95%: 29-86]; respectively; P=.4. The CI of relapse in the ASCT cohort and the Chemo cohort were 21% [CI95%: 0-47] and 27% [CI95%: 2-51], respectively; P=.8

Conclusions

In this retrospective registry-based, matched cohort study of HIV+ patients with large B-cell NHL we found a non-significant effect of ASCT as consolidation treatment in 1st CR patients, in terms of survival and relapse incidence. Nevertheless, due to the observed favorable tendency, future analysis including a higher number of patients and, eventually, randomized clinical studies, should be performed to further clarify these observations.

Table 1:

Patients and transplant features

ASCT cohort
Chemo cohort
n=10%n=20%
Prior AIDS defining disease 43%  30%  p=NS 
Age at lymphoma diagnosis: median (range) 40 (34-60.5)  43.5 (30-56.5)  p= NS 
Male sex 7 70 14 70 p= NS 
Histology      
Diffuse large B cell / Plasmablastic 8 / 2 80 / 20 18 / 2 90 / 10 p= NS 
IPI at diagnosis (>2) 7 70 14 70 p= NS 
Ann Arbor stage at diagnosis (>II) 9 90 16 80 p= NS 
Treatment      
Rituximab use 5 50 10 50 p= NS 
Number of treatment lines: median (range) 1 (1-2)  1 (1-2)  p= NS 
Months from diagnosis to end of chemo: median (range) 5.8 (3.5-11)  4.3 (2.4-7.4)  p=NS 
ASCT cohort
Chemo cohort
n=10%n=20%
Prior AIDS defining disease 43%  30%  p=NS 
Age at lymphoma diagnosis: median (range) 40 (34-60.5)  43.5 (30-56.5)  p= NS 
Male sex 7 70 14 70 p= NS 
Histology      
Diffuse large B cell / Plasmablastic 8 / 2 80 / 20 18 / 2 90 / 10 p= NS 
IPI at diagnosis (>2) 7 70 14 70 p= NS 
Ann Arbor stage at diagnosis (>II) 9 90 16 80 p= NS 
Treatment      
Rituximab use 5 50 10 50 p= NS 
Number of treatment lines: median (range) 1 (1-2)  1 (1-2)  p= NS 
Months from diagnosis to end of chemo: median (range) 5.8 (3.5-11)  4.3 (2.4-7.4)  p=NS 
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Disclosures:

No relevant conflicts of interest to declare.

Topics:
b-cell lymphomas, chemotherapy regimen, complete remission, lymphoma, lymphoma, non-hodgkin, transplantation, autologous stem cell transplant, rituximab, acquired immunodeficiency syndrome, follow-up

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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